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GETTING  READY 
TO  BE  A  MOTHER 


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THE  MACMILLAN   COMPANY 

NEW  YORK   •    BOSTON'   •     CHICAGO   •    DALLAS 
ATLANTA   •    SAN   FRANCISCO 

MACMILLAN  &  CO.,  Limited 

LONDON   •    BOMBAY   •    CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Lm 

TORONTO 


From,  the  painting  by  Gari  Melchera. 

THE  CAI{J':SS 


THE  BKrrTNNTNO 

"Where  did  I  come  from,  wlicrc  did  you  ])iok  nie  up?"  the 
baby  asked  its  mother. 

She  answered,  hnlf  crvinu,  hiilf  lautihiui;,  and  clasping  the 
baby  to  her  breast  : 

"You  Averc  hidden  in  my  heart  as  its  desire,  my  darlinu". 

"You  were  in  tlio  dolls  of  my  cliildliood's  uaiuos:  and  when 
with  clay  I  made  the  imaue  of  uiy  iiod  every  moiiiing,  I  made  and 
unmade  you  then. 

"You  were  enshrined  with  our  household  ileity.  in  his  worship 
I  worshiped  you. 

"In  all  my  hopes  and  my  loves,  in  my  life,  in  the  life  of  my 
mother  you  have  lived. 

"In  the  lap  of  the  deathless  spirit,  wlio  rules  our  home,  you 
have  been  nursed  for  ages. 

"When,  in  girlhood,  my  heart  was  ojiening  its  petals,  you 
hovered  as  a  fragrance  about  it. 

"Your  tender  softness  bloomed  in  my  youthful  limbs  like  a 
glow  in  the  sky  before  sunrise. 

"Heaven's  first  darling,  twin-born  with  the  morning  light,  you 
have  floated  down  the  stream  of  the  world's  life,  and  at  last  you 
have  stranded  on  my  heart. 

"As  I  gaze  on  your  face  mystery  overwhelms  me;  you  who 
belong  to  all  who  have  become  mine. 

"For  fear  of  losing  you  I  hold  you  tight  to  my  breast.  What 
magic  has  snared  the  world's  treasure  iu  these  slender  arms  of 
mine?" 


From    "The    Crescent    Moon"    (child    poem.s),    l)y    Kabunlrauath 
Tagore. 


GETTING   READY 
TO    BE    A    MOTHER 

A  Little  Booh-  of  Information  ond  Adincc  for  ihc    Young 
Woman  Who  is  Looking  Forward  to  Motherhood 


BY 
CAROLYN  CONANT  VAN  BLARCOM,  R.N. 

AUTHOR    OF    "obstetrical    NURSING,"    "tHE    MIDWIFE    IN    ENGLAND" 

Fortnerhj  Assistant   Suprrinteiidcnt   and   Instructor   in   Obstetrical   Nursing   and   the 

Care    of   Infants    and   Children    at    the    Johns    Hopkins   Hospital    Training 

School  for  Nurses.     Hnnnrnni  Member  of  the  Midwives'  Institute, 

Enijland. 

WITH    AN    INTRODUCTION    BY 

J.  CLIFTON   EDGAR,  M.D. 

Emeritus  Professor  of  Obstetrics  and  Cluiieal  Miduifery  in    the   Cornell   University 
Medical   College ;    Consulting    Obstetriciwi   to    Bellevue   Hospital :    Surgeon 
to    the  Manhattaii   Materniti/   and   Dispensary :    Consulting   Obste- 
trician   to    the   Neir    York   Maternity,   Jewish    Maternity 
and  Greenwich  General  Hospitals. 

AND 

FREDERICK  W.  RICE,  M.D. 

Associate    Professor    of    Obstelries,    New    York    University    and    Bellevue    Hospital 

Medical   College;    Attending    Obstetrician    to   Bellevue   Hospital;    Assistant 

Surgeon   to    the   Manhattan   Maternity  and   Dispensary:    Assistant 

Surgeon  to  St.   Bartholomew's  Clinic  and  Hospital. 


WITH  SEVENTY  ILLUSTRATIONS 

THE  MACMILLAN  COMPANY 
1922 

All  Rights  Reserved 


PRINTED   IN    THE   UNITED   STATES    OF   AMERICA 


Bioiosr 
Ubkar/ 


GIFT  PAOIFiO  OOAST   JOURNAL 
OF   NURSING  TO  HYG£Ji>J£  DEPT 


Copyright,  1922, 
By  the   MACMILLAN  t'OMPANV. 


Set  up  and  elt'ctrotyped.     Published  December,  1922. 


V 


BIOLOGY 
LIBRARY 


TO 

THE  BABY, 

UPON       WHOSE       WPXLBEING 

DEP?:XDS  THE  FUTURE 

OF    THE    RACE 


743698 


PREFACE 

The  young  woman  wlio  is  lookinf?  forward  to  motherhood 
is  very  often  torn  by  sliai'i)ly  conHictinji'  amotions.  Her 
eagerness  to  have  a  baby  and  her  happy  anticipations  may 
be  dimmed  by  fears  and  misgivings,  by  superstitious  and  er- 
roneous beliefs  born  of  an  ignorance  that  is  little  less  than 
pathetic.  A  little  information  about  physiological  func- 
tions and  an  explanation  of  some  of  the  facts  of  mother- 
hood prove  to  be  very  reassuring  to  the  mystified,  unin- 
formed young  woman. 

There  is,  too,  the  immeasurably  important  question  of 
the  expectant  mother's  personal  hygiene — the  general 
scheme  of  her  living  in  such  a  way  as  to  promote  her  own 
and  her  baby's  welfare — concerning  which  the  average 
young  woman  is  almost  wholly  ignorant. 

But  the  busy  doctor,  who  gives  of  himself,  impartially, 
to  a  large  number  of  patients,  often  finds  it  difficult  to  dis- 
cuss with  each  one,  in  a  leisurely,  reassuring  way,  the  facts 
that  he  would  like  to  have  her  grasp,  the  misinformation 
he  would  like  to  dispel  and  the  small  but  influential  de- 
tails of  her  daily  life  that  he  wishes  her  to  consider.  It 
is  just  such  simple  information  and  such  details  of  per- 
sonal hygiene  that  T  have  attempted  to  set  forth  in  this 
little  book,  with  the  hope  that  it  may  help  the  expectant 
mother  intelligently  and  confidently  to  do  her  part  in  mak- 
ing ready  for  the  baby ;  and  to  spend  the  period  of  her  ex- 
pectancy in  a  happy  frame  of  mind,  free  from  haunting 
anxieties.  And  I  have  given  some  space  to  a  description 
of  the  course  of  the  baby's  development  in  order  that  his 


xii  PREFACE 

mother  might  have  an  abiding;  sense  of  his  reality  and  his 
need  of  her  protecting  care  from  the  very  moment  of  his 
origin. 

In  no  sense  does  this  book  replace  the  doctor's  care,  for 
it  is  merely  a  composite  of  the  advice  about  simple,  every- 
day little  things  which  the  majority  of  obstetricians  give 
to  the  average,  normal  woman.  I  have  stressed  the  fact 
that  the  first  need  of  both  mother  and  baby,  from  the  be- 
ginning of  pregnancy,  is  supervision  by  a  physician  and 
that  such  advice  as  these  pages  offer  is  of  value  only  as  it 
forms  a  part  of  his  personal  care. 

I  have  drawn  information  from  "The  Practice  of  Ob- 
stetrics," by  J.  Clifton  Edgar,  IM.  D. ;  "Obstetrics,"  by  J. 
Whitridge  Williams,  M.  D. ;  "  The  Prospective  Mother, ' ' 
by  J.  Morris  Slemons,  M.  D. ;  "  The  Diseases  of  Infants 
and  Children,"  by  J.  P.  Crozer  Griffith,  M.  D.  and  "The 
Newer  Knowledge  of  Nutrition,"  by  E.  V.  McCollum, 
Ph.  D.,  Sc.  D.  I  am  deeply  indebted  to  Dr.  J.  Clifton 
Edgar,  Dr.  Frederick  W.  Rice  and  Dr.  John  W.  Harris  for 
helpful  advice  and  criticisms  and  to  ^liss  Louise  A.  Scho- 
field  for  editorial  assistance.  Practical  suggestions  have 
been  generously  contributed  by  other  doctors,  and  by 
nurses,  in  this  country  and  Canada,  whose  effective  work  is 
inspired  by  their  belief  that  the  future  welfare  of  our  race 
depends  upon  the  care  given  to-day  to  maternity  patients 
and  their  babies. 

Carolyn  Conant  Van  Blarcom. 

149  East  40th  Street 
New  York  City 


IXTRODICTION 

Tlio  child-bearinp:  function  is  a  \sondvrh\\\\  complex 
physiological  phenomenon.  It  affects  and  is  influenced  by 
almost  every  organ  and  tissue  in  the  human  body. 

The  body  of  the  female  child  from  the  earliest  weeks  of 
its  life  in  its  mother's  womb,  while  receiving  nourishment 
from  her  body,  through  infancy  and  the  years  of  child- 
hood to  maturity  is  being  gradually  molded  and  developed 
for  the  special  carrying  out  oi  this  one  function — the 
crowning  and  most  vital  act  of  woman. 

Although  the  child-bearing  function  is  the  origin  and 
source  of  the  human  race,  existing  throughout  the  ages,  the 
processes  connected  with  it  have  only  in  recent  years  been 
clearly  understood. 

Our  present-day  knowledge  of  the  processes  connected 
with  childbirth  makes  it  easy  to  understand  how,  in  the 
early  ages  of  the  human  race,  the  function  was  a  normal 
function,  with  little  or  no  danger  to  mother  or  child. 
But  with  the  gradual  growth  of  the  race,  with  the  begin- 
ning of  the  struggle  for  existence  and  the  appearance  and 
spreading  of  disease,  all  interfering  with  the  natural 
groAvth  and  development  of  the  body,  the  function  of  child 
bearing  ceased  to  be  a  normal  function,  as  designed  by 
its  ]\Iaker.  and  became  one  fraught  witli  dangers  to  both 
mother  and  child.  Xevertheless,  tlii'ougli  ignorance  of  these 
changes  brought  on  by  civilization,  tlie  idea  that  the  func- 
tion is  a  normal  process,  the  risk  slight  and  fatalities  in- 
frequent and  wlien  occurring,  inevitable,  is  the  almost  uni- 
versal belief  to-day. 

The  dangers  to  the  life  of  the  mother  and  child  in  the 
carrying  out  of  this  function  are  well  known  to  the  medi- 


xiv  INTRODUCTION 

cal  profession,  as  well  as  the  fact  that  for  the  most  part 
they  are  preventable.  Yet  in  spite  of  this  knowledge,  each 
year  brings  forth,  unchanging,  its  toll  in  fatalities  and 
countless  numbers  of  invalid  mothers,  with  the  inevitable 
destroying  factor  of  the  happiness  of  the  home. 

Statistics  are  available  to  show  that  less  than  half  of  all 
pregnancies  are  normal  and  that  the  illness  and  loss  of 
human  life,  from  causes  associated  with  childbirth,  are  dis- 
tressingly and  needlessly  high. 

Failure  to  get  these  facts  to  the  public ;  failure  to  teach 
lay  Avomen  the  dangers  to  be  avoided  and  the  methods  of 
protection,  is  one  very  important  reason  why  there  has 
been  no  decrease  in  the  high  mortality  rates. 

During  the  past  ten  years,  maternity  hospitals  and  pri- 
vate and  public  health  bodies,  in  various  parts  of  the 
country,  have  obtained  wonderful  results,  locally,  in  reduc- 
ing infant  and  maternal  mortality,  by  giving  to  large 
groups  of  prospective  mothers  information  concerning  the 
common  dangers  associated  with  childbirth  and  how  they 
might  best  be  prevented. 

If  every  expectant  mother,  no  matter  what  her  status  or 
location,  followed  the  simple,  practical  advice  which  this 
book  offers,  the  rate  of  illness  and  death  among  our  mothers 
and  babies  would  be  materially  lessened. 

This  book,  therefore,  so  complete  in  its  information  on 
every  subject  pertaining  to  the  mother  during  pregnancy 
and  confinement  and  of  the  care  of  the  newborn  infant, 
should  be  far  reaching  in  its  beneficial  results. 

It  is  a  book  containing  knowledge  which  every  physician 
must  admit  that  expectant  mothers  should  have,  and  which 
a  large  number  of  expectant  mothers  are  now  earnestly 
seeking  for  their  own  protection  and  that  of  their  newborn. 

J.  Clifton  Edgar,  M.  D. 
Frederick  W.  Rice,  M.  D. 

New  York  City 
November,  1922 


CONTENTS 


PAGE 

Preface        xi 

Introduction,  by  J.  Clifton  Edgar,  M.D.,  and  Fred- 
erick W.  Rice,  M.D xiii 

CHAPTER 

I     Getting  Ready  to  Be  a  Mother 1 

II    Signs  that  a  Baby  is  Coming 11 

III  Where  the  Baby's  Life  Begins 20 

IV  How  the  Baby  Develops  Before  He  is  Born     ...  34 
V     Taking  Care  of  the  Baby  Before  He  Comes     ...  46 

VI     Making  Ready  for  the  Baby 82 

VII     The  Baby's  Arrival 98 

VIII     The  Baby 's  Mother 114 

IX     The    Mother  's    Care    of    Herself — for    the    Baby  's 

Sake 138 

X     The  Mother's  Care  of  Her  Baby 148 

XI     The  Nutrition  of  Mother  and  Baby 226 


^«u^w^';S 


LIST  OF  ILLUSTRATIONS 

•'The  Caress"  by  Gari  Mclcliois Frontispiece 

Chapter  III. 

no.  PAGE 

1.  Diagram  of  pelvis 21 

2.  Side  view  of  female  generative  organs 23 

3.  Front  view  of  female  generative  organs 25 

4.  Diagram  of  human  ovum 26 

5.  Front  view  of  breast 32 

Chapter  IF. 

6.  Diagram  showing  process  of  cell  division 36 

7.  Diagram  of  baby,  cord,  membranes  and  placenta  within  the 

uterus 38 

8.  Appearance  of  the  baby  at  different  stages  of  development  40 

9.  Position  of  baby  in  the  uterus  just  before  birth     ...  42 

Chapter   V. 

10.  Front  and  side  views  of  maternity  corsets 59 

11.  Front,    side    and     back    views    of    homemade    abdominal 

binder  and  breast  bandage,   applied 60 

12.  Abdominal  binder  used  in  Fig.  11 61 

13.  Front  and  back  views  of  homemade  stocking  supporters     .  62 

14.  Eight-angled  position  for  relief  of  swollen  feet  and  legs     .  71 

15.  Lying  with  hips  elevated  to  relieve  swelling  of  vulva     .      .  73 

Chapter  VI. 

16.  Leggings  for  use  at  the  baby's  birth 88 

17.  Pad  made  of  newspapers,  to  protect  bed 90 

18.  Pattern  for  baby's  petticoat 92 

19.  Pattern  for  baby's  dress 93 

20.  Outfit  of  satisfactory  baby-clothes 94 

21.  Baby 's  toilet  tray 96 

xvii 


xviii  LIST  OF  ILLUSTRATIONS 
Chapter  FII. 

FIO.  PAGE 

22.  Diagram  showing  cervix  in  process  of  being  dilated     .      .  101 

23.  Drawing  showing  descent  of  baby  during  birth  ....  104 

24.  Helping  the  baby  to  breathe HI 

Chapter  VIII. 

25.  Supporting  heavy  breasts  with  straight  binder   ....  118 

26.  Supporting  heavy  breasts  by  means  of  three  folded  towels  119 

27.  Indian  binder  for  heavy  breasts 120 

28.  Protecting   nipples  with    sterile   gauze 121 

29.  Position  of  mother  and  baby  while  nursing  in  bed  .      .      .  123 

30.  Using  shield  to  protect  sore  nipples,  while  nursing  baby     .  124 

31.  Nipple  shield  used  in  Fig.  30 125 

32  to  38,  inclusive.     Bed  exercises 128  to  131 

39.  Knee  chest  position 132 

40.  Walking  on  all  fours 133 

Chapter  X. 

41.  Baby's  weight  chart 151 

42.  Diagram  of  first  teeth 153 

43.  Appearance  of  fresh  cord  immediately  after  birth  .      .      .  154 

44.  Appearance  of  cord  four  days  after  birth 155 

45.  Appearance  of  navel  after  cord  has  dropped  off  .  '   .      .      .  155 

46.  Appearance  of  normal,  well  healed  navel 156 

47.  Preparing  the  baby's  milk 169 

48.  Position  in  which  to  hold  baby  and  bottle  for  feeding     .  172 

49.  Holding  baby  upright  after  feeding  to  prevent  colic     .      .  173 

50.  Putting  the  baby  into  his  bath 185 

51.  Supporting  the  baby's  head  above  water  while  giving  bath  186 

52.  Dry,  sterile  cord  dressing 189 

53.  Flannel  band  over  cord  dressing 190 

54.  Putting  on  the   straight   diaper 191 

55.  The  diaper  in  Fig.  54  applied 192 

56.  The   Sutton   poncho 198 

57.  Method  of  carrying  baby  to  support  back  and  head       .      .  200 

58.  Training  the  baby  to  use  a  chamber 202 

59.  Elbow  cuffs  to  prevent  thumb-sucking 203 

60.  Immersing  baby  for  bran  or  mustard  bath 209 


LIST  OF  ILLUSTRATIONS  xix 

FIO.  PAGB 

61.  Putting  the  baby  into  a  wet  pack 210 

62.  The  baby  in  a  wet  pack 211 

63.  Diagrams  showing  successive  steps  in  giving  pack     .      .      .  213 

64.  Giving  the  baby  an   enema 217 

65.  Quilted  robe  for  the  premature  l)abv 220 

66.  Bed  for  premature  baliy  improvised  from  a  clothes  basket  221 

67.  The  baby  in  a  basket,  ready  to  travel 224 


GETTINCx  READY 
TO  BE  A  MOTHER 


CHAPTER  I 
GETTING  READY  TO  B^  A  MOTHER 

How  does  it  seem  to  you — the  coining  of  a  b.aby?  ,  . 

Does  it  seem  the  most  amazing  ci  miiacles,  so  stirring  in 
its  beauty  and  mystery  that  you  are  eager  to  make  ready 
and  prepare  for  it  fitly? 

Or  have  you,  perhaps,  come  to  share  the  general  feeling 
that  motherhood  is  a  natural  state  which  one  accepts  when 
it  comes,  but  need  not  prepare  for? 

This  attitude  seems  to  go  back  to  a  very  old  and  deeply 
rooted  conviction  that,  as  women  always  have  had  babies 
and  have  had  them  through  the  working  of  one  of  Nature's 
laws  that  has  been  operating  over  and  over  throughout  the 
ages,  they  doubtless  will  continue  to  have  them  in  the  same 
old  way,  and  the  entire  matter  may  well  be  left  to  take 
care  of  itself.  As  to  the  baby,  when  he  comes,  one  may 
expect  that  the  ability  to  care  for  him  will  come  too. 

Because  of  this  reasoning,  or  lack  of  it,  it  has  been  a 
fairly  general  custom  for  the  woman  who  expected  a  baby 
to  seek  her  doctor's  aid  only  when  she  went  into  labor,  or 
shortly  beforehand,  and  to  give  no  thought  to  the  care  of 
her  baby  until  he  was  bom.  All  too  often  the  mother  has 
died,  because  of  this  tardy  care,  been  injured  or  become  an 
invalid,  while  equally  sad  things  have  happened  to  the  baby 
— and  needlessly  so. 

But  now,  happily,  a  great  change  is  taking  place  in  the 
realm  of  mothers  and  babies.  We  still  realize,  of  course, 
that  childbearing  is  a  natural  function,  but  we  know  that 
conditions  must  be  made  favorable  for  the  smooth  working 

1 


2     GETTING  READY  TO  BE  A  MOTHER 

of  this  natural  law  if  all  is  to  be  well ;  that  for  the  sake  of 
both  mother  and  baby  it  is  of  urgent  importance  to 
give  thought  and  care  to  the  baby  during  the  nine  months 
before  he  is  born. 

There  is  little  doubt  that  the  most  critical  period  in  one 's 
life  :s  the  first  ten  months — the  nine  months  before  birth 
and  the  firsc  month  afterward — and  that  the  care  which  is 
gixsii  during  these  months  influences  one's  physical  state, 
for  good  or  ill,  throughout  all  the  rest  of  life.  In  the  light 
of  this  knowledge,  women  arc  more  and  more  generally 
seeking  and  being  given  "prenatal  care,"  which  is  care 
before  the  baby  is  born,  together  with  advice  and  instruc- 
tions which  fit  them  to  assume  motherhood  safely  and  suc- 
cessfully. 

Ideal  prenatal  care  would  really  begin  during  the  ex- 
pectant mother's  own  infancy,  for  the  chances  of  a  normal 
pregnancy,  labor  and  lying-in  period  are  greatly  increased 
by  good  care  during  the  early  j^ears  of  life.  But  for  the 
time  being  we  shall  have  to  content  ourselves  with  an  ef- 
fort to  extend,  as  Avidely  as  possible,  the  care  that  is  now 
known  to  be  beneficial  for  expectant  mothers  from  the  be- 
ginning of  pregnancy. 

This  prenatal  care  is  undertaken  in  much  the  same  spirit 
in  which  one  makes  a  garden,  for  example.  AVe  know,  of 
course,  that  plants  which  are  neglected  sometimes  grow 
and  blossom  satisfactorily,  though  one  would  not  think  of 
depending  upon  them  to  do  so.  But  we  have  learned  that 
plants  that  are  given  the  care  and  protection  that  they 
need  are  almost  certain  to  flourish  and  bloom  after  the 
manner  of  their  kind. 

Experience  teaches,  however,  that  this  care  must  be 
regular  and  sustained  and  always  given  for  the  twofold 
purpose  of  preserving  the  plants  from  injury  as  well  as 
nourishing  them.     Accordingly  we  put  them  in  good  soil, 


GETTING  READY  TO  BE  A  MOTHER    3 

to  begin  -with,  and  then  give  water,  sunshine  or  shade,  ac- 
cording to  their  respective  needs,  and  we  take  care  to  pro- 
tect them  from  tlie  destructive  effects  of  harmful  insects, 
blights,  weeds  or  anything  which  may  be  unfavorable  to 
their  healthy  progress.  AVe  do  not  close  our  eyes  to  the 
fact  that  these  harmful  conditions  are  possible.  Instead, 
we  are  anxious  to  find  out  all  about  them — what  causes 
them  and  how  to  recognize  tiicm — in  order  that  we  may 
prevent  or  remove  them  before  they  do  serious  damage. 

Many  women,  nowadays,  arc  taking  just  that  kind  of 
attitude  toward  motherhood.  They  begin  ])y  consult- 
ing a  doctor  as  soon  as  they  know  that  they  are  pregnant, 
because  they  appreciate  the  importance  of  doing  so.  They 
study  eagerly  the  questions  relating  to  motherhood;  the 
structure  and  workings  of  those  parts  of  their  own  bodies 
which  are  concerned  with  the  baby's  creation;  how  he 
evolves  within  them;  what  he  needs  during  those  nine 
months  of  development;  what  practices,  what  conditions 
are  bad  for  the  baby  and  themselves ;  what  they  can  do  to 
avoid  or  correct  these  and  how  they  can  help  to  make 
things  go  smoothly. 

The  women  who  face  the  facts  of  motherhood  in  this 
way  generally  go  through  the  entire  adventure  normally 
and  successfully,  as  Nature  intended  they  should.  More 
than  this,  those  women  who  place  themselves  under  a  doc- 
tor's care  from  the  beginning  of,  or  early  in,  pregnancy, 
are  greatly  reassured  to  find  out  how  much  can  be  done 
to  safeguard  them,  and  they  do  not  have  that  fear  of  the 
approaching  birth  which  is  suffered  by  so  many  women 
who  do  not  know  nor  understand  what  is  going  on. 

The  results  of  the  painstaking  work  and  study  which 
have  been  carried  on  to  increase  the  comfort  and  safety 
of  mothers  and  babies  have  made  it  possible  for  the  doc- 
tors to  plan  something  of  a  routine  which  they  find  ad- 


4     GETTING  READY  TO  BE  A  MOTHER 

visable  for  their  patients  to  adopt.  To  begin  with,  it  is 
quite  plain  that  the  first  need  of  every  expectant  mother 
is  examination  and  measurement,  early  in  pregnancy,  by 
a  good  physician.  The  information  thus  obtained  helps  the 
doctor  to  foretell  the  kind  of  labor  that  his  patient  is  likely 
to  have,  and  by  planning  for  it  ahead  of  time  he  is  often 
able  to  save  her  much  harm  and  suffering.  An  early  ex- 
amination also  enables  the  doctor  to  discover  and  correct 
any  slight  trouble  which  may  exist  at  that  time  and  which 
might  grow  worse  if  not  treated,  and  to  advise  his  patient 
about  the  general  care  which  he  wishes  her  to  take  of  her- 
self throughout  pregnancy.  In  regard  to  this  care,  doc- 
tors are  generally  agreed  that  the  average  woman  needs 
to  do  little  more  than  observe  the  ordinary  rules  of  personal 
hygiene,  which  as  a  matter  of  fact,  should  be  followed  by 
all  of  us ;  that  is,  she  should  live  a  simple,  regular  life  as  to 
diet,  fresh  air,  exercise,  rest,  sleep,  diversions,  etc.  This 
all  sounds  simple  enough  and  as  a  matter  of  course,  but 
it  is  usually  overlooked  in  spite  of  being  of  the  most  ur- 
gent importance  to  both  mother  and  baby. 

This  advice  varies  in  little  things,  here  and  there,  among 
different  doctors,  but  in  the  main  it  is  about  the  same  the 
world  over,  where  thought  is  being  given  to  the  care  of 
expectant  mothers.  For  no  matter  where  they  are  or  what 
their  status,  their  needs  in  general  are  the  same.  They 
need  a  doctor's  supervision  and  they  need  to  practice  the 
principles  of  personal  hygiene. 

Accordingly,  in  addition  to  making  an  early  examina- 
tion and  giving  instructions  about  the  regulation  of  her 
daily  life,  the  doctor  usually  wants  to  see  his  patient  and 
make  certain  observations  every  little  while  during  preg- 
nancy, just  to  make  sure  that  everything  is  going  as  it 
should  and  to  be  in  a  position  to  discover  the  earliest  and 
slightest  symptoms  of  complications. 


GETTING  HEADY  TO  BE  A  MOTIIKK  5 

In  the  old  clays  there  were  certain  complications  asso- 
ciated with  childbirth  which  the  doctors  did  not  know  how 
to  prevent  and  sometimes  could  not  cure — complications 
which  were  bad  for  both  mother  and  baby.  But  now  they 
know  a  great  deal  about  both  preventing  and  curing  even 
the  most  serious  of  these  complications.  They  have  discov- 
ered, for  one  thing,  that  many  conditions  which  give  seri- 
ous trouble  during  labor,  or  soon  afterwards,  actually  have 
their  beginnings  during  pregnancy,  and  sometimes  very 
early. 

Quite  evidently,  then,  it  means  a  great  deal  to  the  ex- 
pectant mother  to  have  the  doctor  discover  and  treat  these 
complications  before  they  have  had  time  to  become  serious. 
But  he  can  give  early  treatment  only  if  he  knows  about  the 
symptoms  of  the  trouble  when  they  first  a-ppear.  Some  of 
these  symptoms  may  be  detected  by  the  Expectant  "mother 
herself  after  they  have  been  explained  to  her,  but  some 
of  them  can  be  discovered  only  by  a  doctor  or  a  nurse. 
That  is  why  it  is  important  for  the  doctor  to  see  his  patient 
at  frequent  intervals  during  pregnancy;  about  once  a 
month  during  the  first  half  and  every  two  weeks  after- 
wards. 

He  sees  her  for  much  the  same  reasons  that  the  house- 
wife looks  over  the  contents  of  her  darning  basket — not 
once  and  for  all  time,  but  regularly,  once  a  week,  over  and 
over  and  over.  She  searches  each  time  not  for  holes  alone, 
but  for  thin  places,  too ;  an  occasional  broken  thread  or  the 
beginning  of  a  "  run, ' '  knowing  how  much  trouble  she  will 
save  herself,  later  on,  by  promptly  repairing  the  smallest 
break  or  evidence  of  wear.  She  knows  quite  well  that  there 
are  no  more  holes  because  she  looks  for  them,  than  there 
are  if  she  does  not,  and  that  failure  to  look  for  them  will 
not  keep  the  holes  from  being  there  nor  from  growing  larger. 
No  more  does  the  expectant  mother  develop  a  complica- 


6     GETTING  READY  TO  BE  A  MOTHER 

tion  because  she  is  examined,  nor  does  an  existing  condi- 
tion cease  to  exist  because  she  is  not  examined ;  and  yet 
some  women  still  take  just  that  illogical  attitude  toward  ex- 
aminations and  supervision  during  pregnancy. 

One  factor  which  keeps  some  expectant  mothers  from 
seeking  medical  care  is  the  well  meaning  but  dangerous 
counsel  so  freely  offered  by  older  women  who  claim  fitness 
to  advise  by  virtue  of  having  had  several  children  of  their 
own.  Their  lack  of  success,  as  evidenced  by  miscarriages, 
stillbirths,  cliildren  dying  in  early  infancy,  as  well  as  in- 
juries and  disabilities  of  their  own,  is  usually  overlooked 
as  they  press  their  superstitions  and  remedies  upon  the  in- 
experienced and  bewildered  younger  woman.  When  dis- 
aster follows,  as  it  so  often  does,  it  is  very  likely  to  be  as- 
cribed to  the  will  of  God,  and  the  mother's  needless  sacri- 
fice does  not  even  serve  as  a  warning  to  others  who  are 
in  line  for  the  same  kind  of  advice. 

Another  obstacle  to  adequate  prenatal  care  is  sometimes 
found  in  the  husband  who  considers  it  entirely  reasonable 
to  secure  expert  advice  upon  the  subject  of  cattle-raising, 
let  us  say,  or  the  care  and  running  of  his  automobile  or 
about  his  investments,  but  who  has  a  conviction  that  it  is 
normal  and  natural  for  women  to  have  children  without 
making  what  he  considers  a  fuss  about  it.  He  may  cher- 
ish, too,  a  suspicion  that  it  is  not  altogether  good  for  his 
wife  to  be  thinking  too  much  about  her  condition.  His 
mother  never  began  bothering  until  the  baby  came. 

On  the  other  hand,  many  husbands  show  the  tenderest 
solicitude  for  their  wives  throughout  pregnancy  and  would 
be  only  too  eager  to  have  them  enjoy  all  the  benefits  of 
prenatal  care,  if  they  only  knew  and  understood  about  it. 
The  expectant  mother  will  be  wise,  therefore,  if  she  under- 
takes to  convince  her  husband,  if  need  be,  that  her  occupa- 
tion of  bearing  and  rearing  children  merits  quite  the  same 


C}p]TTTNCJ   KKADV  TO  UK  A   MOTIIKR  7 

thoughtful  attention  as  his  work,  to  which  he  devotes  his 
best  powers. 

How  easy  and  wortli  while  this  may  he  was  demonstrated 
a  couple  of  years  ago  at  a  count}'  fair  whicli  was  attended 
by  a  very  intelligent  fanner  and  liis  wife.  The  farmer 
was  interested  in  hog-raising  and  both  he  and  his  wife  ac- 
cepted without  question  tlie  fact  that  success  in  this  enter- 
prise could  be  achieved  only  tlirough  serious  study  and  the 
most  painstaking  care.  ]5ut  as  to  childbearing,  if  they 
thought  of  it  at  all,  they  looked  upon  it  as  simply  one  of 
those  natural  functions  whicli  always  had  and  doubtless 
always  would  take  care  of  itself. 

"When  this  couple  reached  the  fair  the  farmer  entered 
one  of  his  fine  animals  in  a  prize-winning  contest  and  as 
there  was  a  baby  contest,  too,  the  wife  entered  their  little 
son.  In  due  time  the  judges  inspected  the  various  con- 
testants and  it  was  found  that  point  by  point  the  farmer's 
hog  measured  up  to  all  of  the  standards  of  perfection  for 
his  kind  and  easily  won  the  first  prize.  Not  so  with  the 
baby;  point  by  point  he  fell  below  even  a  moderate  aver- 
age of  what  a  baby  should  be  and  was  outranked  by  many 
of  his  more  robust  infant  competitors. 

As  various  admirers  discussed  hog-raising  with  the 
farmer,  it  became  quite  evident  that  he  had  carefully 
studied  the  question  and  had  applied  to  his  occupa- 
tion the  most  approved  methods  of  which  he  could  learn. 
But  when  the  doctors  and  nurses  at  the  baby  contest  talked 
with  the  crestfallen  mother  about  her  baby,  who  had  seemed 
right  enough  to  her,  they  found  that  she  knew  little  or  noth- 
ing of  the  business  of  being  a  mother;  that  it  had  never 
occurred  to  her  nor  to  her  husband  that  she  might  profit 
by  care  and  instruction  about  herself  and  her  baby  both  be- 
fore and  after  he  was  born.  As  might  be  expected,  she 
had  been  unable  to  nurse  him  and  on  the  Avhole  he  proved 


8     GETTING  READY  TO  BE  A  MOTHER 

to  be  a  pretty  poor  specimen  of  a  baby,  with  a  dismal  out- 
look as  to  health. 

Since  the  mother  was  then  in  an  early  stage  of  another 
pregnancy,  the  doctor  talked  it  all  over  with  her  and  her 
husband.  He  convinced  them  that  such  thoughtful  and 
painstaking  care  as  they  had  devoted  successfully  to  hog- 
raising  were  equally  effective  when  applied  to  baby-raising. 
As  a  result,  the  expectant  mother,  with  her  husband's 
whole-hearted  approval,  placed  herself  under  the  care  and 
supervision  which  she  found  were  available  through  a  pre- 
natal clinic  in  her  vicinity. 

The  happy  sequel  to  that  story  is  that  when  another 
fair  was  held,  a  year  later,  the  farmer  entered  another 
one  of  his  hogs  and  the  wife  her  new  baby,  and  that  this 
baby  held  his  own  with  the  hog  by  taking  a  prize,  too. 

So  sincerely  do  doctors  now  believe  in  the  urgency  of 
having  all  maternity  patients  under  supervision  and  care 
during  the  nine  months  before  the  baby  comes  and  the 
first  several  weeks  afterwards,  that  they  not  only  care  for 
those  women  who  come  to  their  offices,  but  also  give  of  their 
knowledge  and  skill  to  organizations  engaged  in  prenatal 
and  maternity  work.  These  organizations  may  be  visiting 
nurse  associations,  prenatal  clinics,  health  centers  or  dis- 
pensaries. As  the  doctors  are  assisted  by  nursing  staffs 
they  are  able  to  offer  protection,  through  these  channels, 
to  a  very  large  number  of  mothers  and  babies. 

Among  the  women  who  are  cared  for  by  such  organiza- 
tions, or  by  doctors  in  their  private  practice,  there  is  an 
enormous  reduction  in  the  occurrence  of  convulsions,  for  ex- 
ample, abortions,  miscarriages,  stillbirths,  infections  (child- 
bed fever) ,  and  prolonged  and  difficult  labors.  Or,  to  put 
it  the  other  way  round,  good  care  started  during  early 
pregnancy  and  continued  throughout  labor  and  the  lying-in 
period  gives  both  mother  and  baby  enormously  increased 


GP]TTINa  KEA13V  TO  JiE  A  MOTHER  9 

chances  to  live  and  enjoy  ffood  liealtli.  One  reason  Avhy 
the  baby  is  so  mucli  better  off  is  that  good  care  practically 
always  enables  his  mother  to  nurse  him,  for,  except  in  ex- 
tremely rare  cases  wlion  there  is  a  definite  physical  dis- 
ability, as  tuberculosis  for  example,  every  mother  can  nurse 
her  baby  if  she  really  wants  to  and  if  she,  the  doctor  and 
nurse  bend  all  their  onorgies  to  accomplish  this  happy 
end.  A  baby  who  is  not  breast-fed  is  defrauded  of  a  pro- 
tection which  is  rightfully  his,  and  usually  because  some- 
one has  failed  to  do  all  in  his  or  her  power. 

Organizations  which  include  doctors  and  nurses  who  can 
give  skilled  care  to  maternity  patients  are  increasing  in 
scope  and  number  throughout  cities,  towns  and  rural  dis- 
tricts in  all  parts  of  the  country.  This  makes  us  hope  that 
before  long  good  care  during  pregnancy,  childbirth  and 
young  motherhood  will  be  available  to  every  woman  in 
the  land.  But  quite  as  earnestly  do  we  also  hope  that 
every  woman  in  the  land  who  is  looking  forward  to  mother- 
hood will  seek  this  care.  Certain  it  is  that  the  expectant 
mother  who  does  seek  care,  whether  from  a  doctor  in  his 
office  or  through  a  prenatal  clinic,  is  approaching  her 
motherhood  in  the  only  way  that  is  safe  for  herself  and 
her  baby.  She  should  realize,  however,  that  although  the 
doctors  can  accomplish  a  great  deal  through  examinations 
and  advice,  they  can  give  the  full  benefits  of  their  skill 
only  to  those  women  who  do  their  part  by  following  in- 
structions faithfully,  week  after  week,  throughout  nine 
months.  The  doctor  cannot  live  his  patient's  life  for  her; 
he  can  plan  and  advise  her  ever  so  wisely,  but  this  counts 
for  very  little  unless  she  lives  as  he  directs. 

The  young  woman  who  sees  her  motherhood  as  a  coveted 
privilege,  crowded  with  happy  possibilities,  who  is  will- 
ing to  bear  its  inconveniences  and  take  the  necessary  pre- 
cautions to  insure  a  satisfactory  outcome,  is  very  likely  to 


10  GETTING  READY  TO  BE  A  MOTHER 

go  through  her  experience  in  good  health  and  buoyant 
spirits.  And  in  the  end  she  will  have  not  only  the  ecstasy 
of  possessing  a  beautiful,  well  baby  who  has  every 
prospect  of  continuing  so,  but  as  the  years  pass  she  will 
have  the  satisfaction  of  knowing  that  she  is  a  better,  more 
helpful,  more  companionable  mother  because  of  being  in 
good  health  herself. 

That  is  the  point  of  good  maternity  care — future  well- 
being  as  well  as  immediate  safety  for  both  mother  and  baby 
— and  it  rests  with  each  woman  to  decide  for  herself  if  she 
is  to  have  such  care. 


CHAPTER  II 
SIGNS  THAT  A  BABY  IS  COMING 

The  ■woman  who  wants  a  bal)y  and  is  in  a  position  to  have 
( ne  is  usually  eager  to  know  hoAV  she  can  tell  when  a  baby 
is  coming.  She  wants  to  know  because  the  babj^'s  coming 
means  so  much  to  her  and  also  in  order  that  she  may  know 
when  to  consult  a  doctor. 

I  am  sorry  to  have  to  admit,  at  the  outset,  that  making 
this  important  discovery  is  far  from  being  a  simple  mat- 
ter. One  would  suppose,  after  all  these  ages,  during  which 
countless  babies  have  been  born  and  countless  pregnancies 
have  been  observed  by  doctors  and  others,  that  there  would 
be  some  known  way  of  finding  out  definitely,  at  an  early 
date,  whether  or  not  a  baby  was  coming.  But  strangely 
enough,  there  is  no  positive  evidence  of  the  baby 's  existence 
within  his  mother's  body  until  eighteen  or  twenty  weeks 
after  his  life  there  has  begun. 

On  the  other  hand,  so  many  symptoms  of  pregnancy 
are  known  to  women,  the  world  over,  that  very  often  an  ex- 
pectant mother  is  correct  when  she  suspects  at  an  early 
date  that  she  is  pregnant,  particularly-  if  she  has  already 
had  a  child.  But  as  the  well-known  sj-mptoms  are  much  like 
those  of  various  conditions  other  than  pregnancy,  even  ex- 
perienced mothers  sometimes  believe  themselves  pregnant 
when  they  are  not.  The  reverse  is  true  also,  for  we  occa- 
sionally hear  of  a  woman  who  fails  to  recognize  the  meaning 
of  the  changes  wliicli  she  notices  in  herself,  and  is  unaware 
of  being  pregnant  up  to  the  very  time  of  going  into  labor. 

11 


12  GETTING  READY  TO  BE  A  MOTHER 

And  so  we  find  that  there  are  some  signs  of  pre^ancy 
wliich  are  only  possible,  since  they  may  be  caused  by  some 
other  conditions ;  others  which  may  be  accepted  as  provable, 
and  a  few  signs  which  are  positive  because  they  are  never 
due  to  any  cause  but  pregnancy. 

The  possible  signs  can  all  be  detected  by  the  expectant 
mother,  herself,  and  may  be  described  as  follows: 

1.  Stopping  of  Menstruation.  This  is  usually  the  first 
symptom  noticed.  Although  it  is  possible  for  the  periods 
to  be  stopped  by  any  one  of  several  other  causes,  the  miss- 
ing of  two  successive  periods,  after  intercourse,  is  a  strong 
indication  of  pregnancy  in  a  healthy  woman  of  the  child- 
bearing  age,  whose  menses  have  been  regular. 

2.  Changes  in  the  Breasts.  These,  also,  occur  early. 
The  breasts  usually  increase  in  size  and  firmness,  and  many 
women  complain  of  throbbing,  tingling  or  pricking  sensa- 
tions and  a  feeling  of  tightness  and  fullness.  The  breasts 
may  be  so  tender  that  even  slight  pressure  is  painful.  The 
nipples  become  larger  and  more  prominent;  they  and  the 
colored  circle  of  skin  around  them  grow  darker,  while  the 
veins  and  the  glands  that  feel  like  little  lumps  under  the 
skin  become  more  noticeable.  If,  in  addition  to  these  symp- 
toms, it  is  possible  for  a  woman  who  has  not  had  children 
to  squeeze  from  her  nipples  a  pale  yellowish  fluid,  called 
colostrum,  she  may  feel  almost  certain  that  she  is  preg- 
nant. But  it  must  be  remembered  that  these  symptoms, 
also,  may  be  due  to  causes  other  than  pregnancy;  that 
even  milk  in  the  breasts  may  be  present  in  a  woman  who 
has  borne  children,  for  months,  or  possibly  years,  after  the 
birth  of  her  last  baby. 

3.  "Morning  sickness,"  as  the  name  suggests,  is  nausea, 
sometimes  accompanied  by  vomiting,  from  which  many  ex- 
pectant mothers  suffer  the  first  thing  in  the  morning.  This 
varies  from  a  little  nausea,  when  first  raising  her  head, 


SIGNS  THAT  A  BABY  IS  COMING  13 

to  repeated  attacks  of  vomiting:  during'  the  day  and  even 
dnrinpr  tlie  nitrlit.  As  a  rule,  however,  the  discomfort  is 
experienced  during  the  early  part  of  the  day  oidy.  Morn- 
ing sickness  may  set  in  immediately  after  conception,  but 
begins  al)ont  the  sixth  week,  as  a  rule,  and  lasts  until  the 
third  or  fourth  month.  It  occurs  in  about  half  of  all  preg- 
nancies and  is  particularly  common  among  women  who  are 
pregnant  for  the  first  time.  On  the  other  hand,  one  must 
not  forget  that  many  non-pregnant  women  suffer  from  nau- 
sea in  the  morning;  many  women  go  through  pregnancy 
without  any  such  disturbance,  while  others  are  entirely 
comfortable  in  the  morning  but  nauseated  during  the  lat- 
ter part  of  the  day. 

4.  Frequent  Urination.  There  is  usually  a  desire  to 
pass  urine  frequently  during  the  first  three  or  four  months 
of  pregnancy,  after  which  the  tendency  disappears,  but  re- 
turns during  the  later  months.  The  desire  may  be  due  in 
part  to  nervousness,  but  is  largely  caused  bj^  pressure 
made  upon  the  bladder  by  the  growing  baby,  and  not  by 
kidney  trouble,  as  is  sometimes  believed.  For  pressure  on 
the  outside  of  the  bladder  gives  much  the  same  sensation 
as  is  experienced  when  the  bladder  is  full  of  urine.  After 
the  baby  grows  to  such  a  size  that  he  pushes  up  into  the 
abdomen  (we  shall  describe  this  later),  he  does  not  press 
upon  the  bladder  and  therefore  ceases  to  create  a  desire  to 
urinate  until  the  last  month  or  six  weeks  before  he  is 
born  when  he  sinks  back  into  the  pelvis. 

5.  Increased  discoloration  of  the  colored  parts  of  the 
skin  is  another  early  symptom  of  pregnancy.  In  addition 
to  the  deepened  tint  of  the  nipples  and  the  circles  around 
them,  a  dark  streak  appears  upon  the  lower  part  of  the 
abdomen,  extending  upward  toward  the  umbilicus,  or  navel. 
There  are  also  the  yelloM'ish,  irregularly  shaped  blotches 
which  sometimes  appear  upon  the  face  and  neck;  dark  cir- 


14  GETTING  READY  TO  BE  A  MOTHER 

cles  under  the  eyes  and  pinkish  or  bluish  streaks  on  the 
abdomen. 

6.  "Quickening"  is  the  name  which  is  commonly  given 
to  the  mother's  first  feeling  of  the  baby's  movements.  It 
occurs  about  tlie  eighteenth  or  twentieth  week,  and  is  re- 
garded by  some  doctors  as  a  positive  sign  of  pregnancy  and 
by  others  as  merely  a  possible  sign.  The  sensation  is  com- 
pared to  a  very  slight  (luivering,  or  tapping,  or  to  the  flut- 
tering of  the  wings  of  a  bird  as  it  is  held  in  one's  hand. 
Beginning  very  gently,  lliesc  movements  grow  more  vigor- 
ous, as  time  goes  on,  until  tlicy  become  very  troublesome  to- 
ward the  latter  part  of  pregnancy,  amounting  then  to  sharp 
kicks  and  blows.  Women  who  liave  had  children  can  usu- 
ally distinguish  between  quickening  and  the  somewhat  simi- 
lar sensation  caused  by  the  movement  of  gas  in  the  intes- 
tines ;  but  a  woman  pregnant  for  the  first  time  may  be 
deceived. 

There  are  many  other  possible  symptoms  of  pregnancy, 
but  their  value  is  very  uncertain  and  as  we  have  seen,  even 
the  ones  described  above  are  not  entirely  dependable.  But 
if  you  have  missed  two  periods ;  if  your  breasts  have  grown 
larger  and  firmer;  if  your  nipples  are  stiffer  and  more 
prominent  and  you  can  squeeze  colostrum  from  them,  you 
may  be  reasonably  certain  that  a  baby  is  coming. 

The  probable  signs  of  pregnancy  are  more  apparent  to 
the  doctor  than  to  the  expectant  mother,  but  there  are  two 
which  you  may  easily  detect : 

1.  Enlargement  of  the  abdomen,  which  is  a  very  impor- 
tant sign,  may  be  noticed  about  the  third  month.  At  this 
stage  a  rounded  mass  may  be  felt  in  the  abdomen  which 
steadily  increases  in  size  as  the  weeks  and  months  slip  by. 
Rapid  enlargement  of  the  abdomen  in  a  woman  of  child- 
bearing  age  may  be  taken  as  fair,  but  not  positive,  evi- 
dence that  she  is  carrying  a  bal)y.     However,  complete  re- 


SKJXS  THAT   A    \',A\',\    IS  CO.MINi;  i:, 

liance  cannot  bo  placed  in  this  siirn,  since  it  is  possil)l('  for 
tiie  abdomen  to  be  cidai'fifd  l>y  a  tnnior,  by  dropsy,  or 
by  fat. 

2.  Painless  contractions  of  the  uterus  (or  womb,  within 
which  the  hal)y  lies  i  hcjiiii  diiriiiii'  the  early  weeks  of  preg- 
nancy and  occur  at  intervals  of  five  or  ten  minutes 
throughout  the  entire  period.  The  expectant  mother  may 
not  be  conscious  (»f  these  contractions  during  the  early 
months,  but  later  she  can  detect  them  by  placing  her  hand 
upon  her  abdomen  and  feeling  the  uterus,  l)eneath  it,  grow 
first  hard  and  then  soft,  as  it  contracts  and  relaxes.  But 
the  probable  signs  of  pregnancy,  like  the  possible  symp- 
toms, may  occur  in  Avomen  who  are  not  pregnant,  and  ac- 
cordingly the  appearan(^e  of  any  one  of  them  alone,  is  not 
of  great  significance. 

The  positive  signs  of  pregnancy,  of  which  there  are  three, 
are  not  apparent  until  the  eighteenth  or  twentieth  week. 
They  relate  to  the  baby,  I)ut  with  one  exception  they  can- 
not be  detected  by  the  expectant  mother.  However,  they  are 
of  such  moment  that  you  will  be  interested  to  know  what 
they  are. 

1.  Hearing  and  counting  the  baby's  heart  beat  is  un- 
mistakable evidence  of  the  baby's  existence.  The  doctor 
sometimes  hears  this  by  resting  his  ear  upon  the  mother's 
abdomen  and  souu'times  by  listening  through  a  stethoscope. 

2.  Ability  to  feel  the  outline  of  the  baby's  body  is  also 
a  positive  sign  of  pregnancy,  if  the  head,  l)Uttocks,  back 
and  extremities  are  unmistakably  made  out  through  the 
mother's  abdominal   Avail. 

3.  Feeling  the  movements  of  the  baby  is  accepted  as  a 
third  positive  sign  of  pi-egnancy.  There  is  some  difference 
of  opinion  concerning  the  value  of  "quickening,"  alone,  as 
a  positive  sign,  but  if  the  baby's  movements  are  felt  by 
the  doctor,  also,  through  tlie  mother's  abdominal  wall,  or 


16         GETTING  READY  TO  BE  A  MOTHER 

by  vaginal  examination,  there  can  be  no  donbt  that  a 
baby  is  there.  Feeling  these  movements  some  time  after 
the  eighteenth  or  twentieth  week,  by  placing  a  hand  upon 
the  abdomen,  is  the  one  positive  sign  which  the  expectant 
mother  may  detect  for  herself. 

Some  Other  Changes  in  the  Mother's  Body  While  the 
Baby  Grows.  In  addition  to  the  signs  and  symptoms 
which  we  have  just  described,  there  are  a  good  many  other 
changes  which  will  take  place  in  your  own  body,  in  the 
course  of  the  baby's  development,  and  you  will  want  to 
learn  about  some  of  them  in  order  that  you  may  know 
what  to  expect. 

The  abdomen.  Of  course,  the  steady  enlargement  of  the 
abdomen  and  the  alteration  in  its  shape,  as  pregnancy  ad- 
vances, is  the  change  that  you  will  be  most  conscious  of. 
As  the  abdomen  grows  larger,  the  skin  which  covers  it  is 
stretched  more  and  more  tightly  with  the  result  that  the 
tissues  just  under  the  surface  sometimes  give  way,  or  split 
and  form  pale  pink  or  bluish  streaks.  These  streaks,  which 
are  called  strm,  grow  white  and  glistening  after  the  baby 
is  born,  so  that  the  abdomen  of  an  expectant  mother  who 
has  had  children,  will  show  silvery  streaks  from  earlier 
pregnancies  and  also  the  bluish  ones  recently  formed. 
These  streaks  are  of  no  consequence  and  I  mention  them 
simply  because  you  are  almost  certain  to  notice  them  and 
may  wonder  what  they  are.  They  may  appear  upon  the 
hips,  thighs  and  breasts  as  well  as  upon  the  abdomen,  if 
the  skin  over  these  parts  is  greatly  stretched. 

The  umbilicus  (navel)  is  deeply  indented  during  about 
the  first  three  months  of  pregnancy,  but  afterwards  the  pit 
steadily  grows  shallower  and  by  the  seventh  month,  it  is 
level  with  the  surface  of  the  abdomen.  After  this  time  the 
navel  may  protrude,  in  which  state  it  is  described  as  a 
"pouting  umbilicus." 


SIGNS  THAT  A  J'.AT.Y  IS  COMING  17 

An  increase  in  the  vaginal  discharge  is  another  change 
Avhieh  you  may  notice  during  tiie  latter  months  of  preg- 
nancy. 

The  changes  in  the  skin  consist  chiefly  of  the  increased 
discoloration  over  various  parts  of  the  body,  which  was 
mentioned  among  the  possible  signs  of  pregnancy.  The 
degree  of  this  discoloration  varies  with  the  complexion  of 
the  individual,  as  blonds  may  be  tinted  but  slightly  more 
than  usual,  while  the  discolored  areas  on  a  brunette  may 
become  almost  black.  As  the  skin  glands  become  more  ac- 
tive, there  is  also  an  increase  in  perspiration  and  sometimes 
the  hair  becomes  much  more  luxuriant  during  pregnancy. 

Changes  in  the  digestive  tract  are  the  morning  sickness 
alread}'  described,  and  constipation.  The  latter  is  suffered 
by  at  least  one  half  of  all  pregnant  women  and  is  due 
chiefly  to  pressure  made  upon  the  intestines  by  the  en- 
larged uterus,  though  weakening  of  the  stretched  abdom- 
inal muscles  may  be  one  cause.  Constipation  is  most 
troublesome  during  the  latter  part  of  pregnancy.  There 
may  be,  also,  heartburn,  acid  stomach  and  intestinal  indi- 
gestion giving  rise  to  gas,  diarrhea  and  cramps.  The  so- 
called  "cravings"  of  pregnancy  are  not  so  common  in  real 
life  as  they  are  in  rumor,  but  the  expectant  mother  may 
show  unexpected  likes  and  dislikes  for  certain  dishes,  pos- 
sibly because  of  her  tendency  to  be  nauseated.  Her  ap- 
petite may  be  very  capricious  during  the  early  weeks  and 
become  almost  ravenous  later  on. 

The  bones  and  teeth  may  grow  softer  during  pregnancy, 
if  the  expectant  mother  does  not  eat  proper  food,  and  as  a 
result  we  hear  of  the  old  beliefs  that  each  baby  costs  the 
mother  a  tooth  and  that  broken  bones  heal  slowly  during 
pregnancy.  Both  of  these  occurrences  are  entirely  un- 
necessary, and  may  be  prevented  by  eating  suitable  food, 
as  will  be  explained  in  the  chapter  on  nutrition. 


18  GETTING  KEADY  TO  BE  A  MOTHER 

The  carriage,  or  mode  of  walking,  is  someAA'hat  affected 
by  pregnancy  l)CL'anse  of  the  inereasetl  size  and  weight  of 
the  abdomen.  In  an  effort  to  liold  herself  erect,  the  expect- 
ant mother  throws  back  her  head  and  shoulders  and  finally 
assumes  a  gait  that  may  be  described  as  a  waddle,  being 
particularlj^  noticeable  in  short  women. 

You  hear  a  good  deal  about  the  thyroid  gland  these 
days,  so  you  may  as  well  know  that  it  is  very  often  enlarged 
during  pregnancy  and  thus  may  form  a  swelling  on  the 
front  part  of  the  neck.  If  you  notice  it  you  might  tell 
your  doctor  but  it  need  not  worry  you  for  it  Avill  almost 
certainly  return  to  its  normal  size  after  the  baby  comes. 

When  to  Expect  the  Baby.  Now  that  you  are  familiar 
with  the  most  apparent  changes  w^hich  will  take  place  in 
your  body  during  pregnancy,  you  are  probably  on  tiptoe 
to  find  out  as  nearly  as  possible  the  date  upon  which  to  ex- 
pect the  baby.  Unfortunately  we  cannot  foretell  the  exact 
date,  for  the  very  simple  reason  that  we  have  no  way  of 
knowing  just  when  pregnancy  begins.  Quite  evidently, 
then,  not  knowing  when  it  begins  w-e  cannot  figure  out  the 
exact  date  upon  which  pregnancy  will  end  in  the  baby's 
birth.  But  we  do  know  that  labor  usually  begins  about 
ten  lunar  months,  or  forty  weeks,  or  from  273  to  280  days, 
after  the  beginning  of  the  last  menstrual  period.  Thus 
the  approximate  date  of  the  baby's  arrival  may  be  esti- 
mated by  counting  forward  280  days  or  backward  85  days 
from  the  first  day  of  the  last  period.  Or,  wiiat  is  perhaps 
simpler  and  amounts  to  the  same  thing,  one  ma}"  add  seven 
days  to  the  first  day  of  the  last  period  and  count  back 
three  months.  For  example,  if  the  last  period  began  on 
June  3,  the  addition  of  seven  days  brings  us  to  June  10, 
while  counting  back  three  months  from  this,  indicates 
March  10  as  the  approximate  date  upon  which  the  baby 
maj'  be  expected. 


SIGNS  TllxVT  A  BABY  IS  COMING  19 

This  is  probal)ly  as  satisfactory  as  any  method  of  estima- 
tion, but  at  best  it  is  only  approximate,  being  accurate  in 
about  one  case  in  twenty.  However,  it  comes  within  a  week 
of  being  correct  in  half  the  cases;  and  is  witliin  two  weeks 
of  the  actual  tlatc  in  ('i<ility  i)er  cent,  of  all  pregnancies. 

Still  another  method  is  to  count  forward  twenty  or 
twenty-two  weeks  from  the  day  upon  which  you  first  feel 
the  baby  move.  This  "(luickcuing, "  as  we  have  seen, 
usually  occurs  about  the  eighteenth  or  twentieth  week,  but 
is  so  irregular  that  it  is  not  Avholly  reliable.  The  possibility 
of  figuring  out  the  date  of  the  baby's  arrival  is  made  still 
more  uncertain  by  the  fact  that  there  is  evidently  consid- 
erable variation  in  the  length  of  entirely  normal  preg- 
nancies. Many  healthy  children  are  born  before  ten  lunar 
months  have  elapsed  since  the  last  menstrual  period,  while 
more  births  occur  after  than  on  the  expected  date.  The 
first  pregnancy  is  usually  shorter  than  later  ones,  and 
women  who  are  well  nourished  and  well  cared  for  usually 
have  longer  pregnancies  than  those  who  are  not. 

Taking  it  as  a  whole,  the  average  woman  has  unusually 
good  health  during  pregnancy.  She  may  feel  some  weari- 
ness during  the  first  few  months  and  she  may  lose  a  little 
weight,  but  during  the  latter  part  of  the  period  her  general 
health  is  improved  and  there  is  an  increase  of  flesh,  not 
alone  in  the  abdomen,  but  over  the  entire  body,  sometimes 
amounting  to  twenty-five  or  thirty  poiTnds.  She  loses 
about  fifteen  pounds  of  the  increased  Aveight  when  the  baby 
is  born,  and  still  more  during  the  weeks  immediately  fol- 
lowing, when  her  body  returns  to  about  its  original  condi- 
tion. But  very  often  the  experience  of  pregnancy  is  so 
beneficial  that  the  improved  state  of  health  and  nutrition 
which  accompany  it  become  permanent. 


CHAPTER  III 
WHERE  THE  BABY'S  LIFE  BEGINS 

As  you  plan  for  the  care  of  your  baby  during  the  nine 
months  before  he  is  born,  you  will  want  to  know  something 
of  the  place  where  his  life  begins ;  where  one  tiny  cell  is  so 
miraculously  stimulated  and  nourished  that  it  finally  de- 
velops into  a  beautiful  little  body.  Not  only  will  you 
fino  all  of  this  of  absorbing  interest,  but  a  general  idea 
of  the  structures  and  workings  of  those  parts  of  your  body 
where  the  babj^  lives  and  grows  will  help  you  better  to  un- 
derstand some  of  the  doctor 's  precautions  and  to  give  your- 
self intelligent  care  while  your  body  performs  its  supreme 
function. 

To  begin  with,  there  is  the  pelvis.  This  is  a  very  ir- 
regular, bottomless,  bony  basin,  or  curved  canal,  within 
which  lie  the  reproductive  or  generative  organs  to  be  de- 
scribed presently.  The  pelvis  is  really  composed  of  four 
bones  which  are  entirely  separate  in  early  life  but  firmly 
welded  into  one  rigid  structure  in  adults.  I  mention  this 
because  many  women  believe  that  labor  pains  are  caused 
by  a  spreading  or  opening  of  these  bones,  whereas,  as  we 
shall  see  presently,  the  pains  are  really  due  to  the  strong 
contractions  of  the  muscles  of  the  uterus  (or  womb)  in 
which  the  baby  lies,  which  force  the  baby  down  through 
this  inflexible  ring.  You  may  see  in  Fig.  1  how  the  pelvis 
is  placed  in  the  body,  being  interposed  between  the  spinal 
column,  which  it  supports,  and  the  thighs  upon  which  it 
rests.     We  can  feel  two  of  its  prominent  points  on  either 

20 


WHERE  THE   IJABYS   MFK   ISIOGLXS 


21 


side  below  the  waist,  as  our  hips,  and  we  rest  upon  two 
other  projections  while  in  the  sitting  position. 

This  bony  canal  is  drawn  in,  or  narrowed  about  mid- 
way in  its  length  so  that  it  is  broader  above  and  below 
than  it  is  in  the  middle.  You  are  likely  to  hear  the  doc- 
tors speak  of  this  narrow  part  as  the  inlet.    1  thought  you 


colutnTi     ■ 


False     _'',v 

pelvis'. //liV* 


Fig.  1. — Diagram  showing  the  structure  of  the  pelvis  and  its  position 
in  the  body,  the  inlet  being  heavily  outlined. 


would  be  interested  to  know  about  this  for  it  is  largely  in 
order  to  discover  the  size  and  shape  of  the  inlet  that  the 
doctor  is  so  anxious  to  make  certain  examinations  and  meas- 
urements. 

The  wide  part  of  the  pelvis  above  the  inlet  is  called  the 
upper,  or  false  pelvis,  while  the  smaller  cavity  below  is 
known  as  the  true  pelvis.  During  the  early  part  of  preg- 
nancy the  baby  lies  in  the  true  pelvis,  but  as  pregnancy 


22  GETTING  READY  TO  BE  A  MOTHER 

advances  and  he  grows  larger,  he  pushes  up  through  the 
inlet  into  the  larger  pelvis  where  he  remains  until  he  is 
born.  When  that  time  comes  he  must  pass  down  through 
the  inlet  again  on  his  way  into  the  world.  If  this  opening 
is  about  the  usual  size  and  shape  and  the  baby  is  of  an  aver- 
age size,  he  will  usually  pass  tlirough  with  comparatively 
little  trouble.  But  if  the  inlet  is  smaller  than  normal  or  of 
an  unusual  shape,  it  may  ])e  difficult,  or  even  impossible, 
for  the  head  of  a  normal-sized  baby  to  pass  through  with- 
out the  doctor's  assistance.  You  can  see  how  important  it 
is,  therefore,  for  the  doctor  to  know  beforehand  about  the 
size  and  shape  of  the  pelvic  inlet,  since  it  enables  him  to 
plan  to  help  with  the  birth,  if  necessary,  thus  saving  mother 
and  baby  from  exhausting  themselves  in  trying  to  do  the 
impossible.  In  the  old  days  many  mothers  and  babies  were 
injured,  and  sometimes  even  lost  their  lives,  because  doctors 
did  not  know  about  measuring  the  pelvis  and  planning 
ahead  of  time  for  a  difficult  labor.  But  now  they  know 
how  to  make  things  easier  and  safer. 

It  is  worth  mentioning  here  that  proper  care  during  in- 
fancy and  childhood,  with  proper  food,  fresh  air  and  exer- 
cise, helps  to  promote  normal  development  of  the  pelves  of 
little  girls,  and  this  in  turn  tends  to  make  childbirth  nor- 
mal for  these  children  when  they  grow  up  and  are  ready 
to  have  babies  of  their  own. 

The  Generative  or  Reproductive  Organs.  The  pelvis  is 
an  interesting  structure  but  not  nearly  so  interesting  as 
the  generative  organs  which  lie  within  it:  the  uterus  (or 
womb),  tubes  and  ovaries.  These,  with  the  vagina,  are  of- 
ten called  the  internal  genitalia  because  they  are  inside  the 
body.  The  pelvis  practically  remains  rigid  and  inactive 
throughout  pregnancy  and  labor,  but  the  ovaries  and  the 
uterus  are  constantly  active  and  are  concerned  with  an  un- 
dertaking which  is  so  utterly  amazing  that  it  is  far  beyond 


WHERE  THE  IJABY'S  LIFE  BEGINS 


23 


our  powers  of  understanding.     We  can  only  look  on  and 
wonder. 

The  uterus,  or  womb,  in  which  the  baby  develops,  is  a 
firm  little  mass  of  muscle,  which,  in  its  noii-pregrnant  state, 
is  much  the  shape  of  a  slightly  flattened  pear,  about  three 


Top   of 


\Jttrine 

■Utev'vne 
"uoaU    " 


Bladvio 


Cevvix 


RectuYT* 


Fig.  2. — Drawing  showing  the  structure  and  relation  of  the  female 
generative  organs,  as  viewed  from  the  side.  (Drawn  by  Max  Brodel. 
Used  by  permission  of  A.  J.  Nystrom  and  Co.,  Chicago.) 

inches  high,  an  inch  and  a  <iuaiter  wide  at  its  broadest 
point,  three  quarters  of  an  inch  thick,  anil  weighs  about 
two  ounces.  We  usually  speak  of  the  main  part  of  the 
uterus  as  the  body;  the  round  loj)  as  the  fundux  and  the 


24         GETTING  READY  TO  BE  A  MOTHER 

smaller  part  of  the  organ,  below,  as  the  neck  or  cervix. 
This  important  little  organ  is  placed  about  the  middle  of 
the  true  pelvis,  with  the  upper  end  pointing  slightly  for- 
ward. (See  Fig.  2.)  It  is  more  or  less  swung  in  this  posi- 
tion by  being  attached  to  ligaments  instead  of  to  any  fixed 
part,  the  ligaments,  in  turn  being  attached  to  the  sides  of 
the  pelvis.  This  explains  why  the  uterus  may  move  about, 
tip  forward  or  backward,  and  how,  by  a  stretching  of  the 
ligaments  that  hold  it,  it  is  able  to  grow  and  push  upwards 
as  pregnancy  advances. 

Within  the  body  of  the  uterus  is  a  flat  cavity  which  is 
somewhat  triangular  in  shape,  with  an  opening  at  each  of 
the  three  corners.  The  two  upper  openings  lead  into  the 
tubes,  which  will  be  described  in  a  moment,  while  a  third 
opening  leads  down  into  the  cervix,  the  lower  end  of  the 
cervix,  in  turn,  protruding  into  the  vagina.  The  upper 
and  lower  ends  of  the  cervix  are  drawn  in  as  though  with 
a  draw  string  so  that  they  are  scarcely  more  than  small 
round  holes.  These  are  called  the  internal  os  and  the  exter- 
nal OS.  Fig.  3  gives  an  idea  of  how  the  cavity  of  the  uterus 
and  the  cervix  would  look  from  the  front,  with  the  tubes 
reaching  out  from  the  upper  corners  of  the  uterus,  and  the 
cervix  opening  into  the  vagina.  The  uterus  is  lined  with 
a  soft  mucous  lining  something  like  the  lining  of  one's 
mouth.  Bear  this  in  mind,  for  this  lining  represents, 
in  part,  the  soil  in  which  the  tiny  human  seed  is  planted 
and  through  which  its  roots  draw  nourishment. 

The  Fallopian  tubes  are  two  little  muscular  passage 
ways,  about  five  inches  long,  which  extend  from  the  two 
upper  corners  of  the  uterine  cavity  toward  the  sides  of  the 
pelvis.  The  tubes  are  very  small  where  they  arise  from 
the  uterus,  but  gradually  grow  larger  toward  their  free  ends 
and  finally  spread  out  into  wide,  funnel-shaped  openings 
that  lead  directly  into  the  abdominal  cavity.     The  tubes, 


WHKRK  TllK  r.AliVS  lAFK   BKOIXS 


also,  are  lined  with  a  raucous  membrane  but  of  a  most 
surprising  kind.  Its  surface  is  covered  with  tiny  hair  like 
projections  which  make  it  something  like  a  brush  with  very 
soft,  moist  bristles.     These  little  hairs  are  in  constant  mo- 


ruTidLuS 


xVlteTi-ne   Cav'\t\i 


\ld.§>-nol  ou^L^ 


Fig.  3. — Diagram  showing  the  structure  and  relation  of  the  female 
generative  organs,  as  seen  from  the  front. 

lion,  waving  and  sweeping  along  in  much  the  same  way 
that  a  field  of  wheat  waves  and  sweeps  in  the  wind.  Re- 
member about  this,  too,  for  it  has  something  to  do  with 
the  very  beginning  of  the  baby. 

The  Ovaries.    Very  near  and  a  little  below  the  tiaring, 
open  ends  of  the  tubes  are  the  ovaries,  the  sex  glands  of  the 


26 


GETTING  READY  TO  BE  A  MOTHER 


female.  There  is  one  on  each  side,  held  in  place  by  liga- 
ments and  they  are  about  the  size  and  shape  of  almonds.  In 
the  ovaries  are  embedded  the  ova,  or  eggs,  the  female  germ 
cells  which  are  concerned  Avith  producing  the  baby  and 
also  with  the  function  of  menstruation. 

Just  a  word  about  what  is  meant  by  "a  cell. "    It  is  sim- 
ply a  tiny  mass  of  jelly-like  substance,  called  protoplasm, 


nucleolus 
or* 


ge-»">n  spot 


nucleus 


Fig.  4. — Diagram  of  human  ovum. 


contained  in  a  thin  membrane  or  skin  and  is  so  small  that  it 
can  be  seen  only  through  a  microscope.  In  its  unmatured 
state  the  ovum  is  a  single  cell,  about  1/125  of  an  inch  in 
diameter.  In  the  protoplasm  there  is  a  spot  called  the 
nucleus  and  within  this  a  smaller  one  called  the  nucleolus, 
or  the  germinal  spot.  These  are  long  names  and  you  need 
not  remember  them  unless  you  want  to,  but  glance  at  Fig. 
4  which  shows  an  ovum  and  you  will  see  that  in  its  general 
structure  it  is  much  like  a  hen's  egg,  for  the  latter  has  a 


WHERE  TllK   ^.A^.^■■S   IJFH  III'XJINS  27 

yolk  within  the  wliite  and  on  the  yolk  a  tiny  speek  or 
germinal  spot.  The  formation  of  eaeh  woman's  full  quota 
of  ova,  fifty  thousand  or  more,  is  probably  complete  at  the 
time  of  her  birth. 

The  vagina  is  a  nniscular  tul)i'.  or  passag-e  way,  leading 
from  the  outside  of  the  body  to  tlic  cervix,  which  you  will 
remember  is  the  lower  ])art  of  tlic  uterus.  The  vagina 
slopes  upward  from  its  opening  and  instead  of  meeting  the 
cervix  evenly  it  meets  it  almost  at  right  angles  and  en- 
eases  it  like  a  sheath  for  about  half  an  incli.  Fig.  2  shows 
how  these  organs  would  appear  if  we  were  looking  at  them 
from  the  side. 

The  Bladder.  Jf  you  will  glance  again  at  P'ig.  2,  you  will 
see  that  just  in  front  of  the  vagina  there  is  a  tiny  ])assage 
leading  up  to  a  sac  which  also  is  in  front  of  the  vagina,  and 
since  in  this  picture  it  is  practically  empty,  it  lies  below 
the  uterus.  This  sac  is  the  bladder  and  you  can  readily 
understand  that  as  the  uterus  enlarges  during  pregnancy, 
it  presses  upon  the  bladdei-  and  this  pressure  on  the  outside 
gives  the  same  sensation  as  is  produced  by  pressure  from 
the  inside  when  the  bladder  is  filled  with  urine.  That  is 
why  the  expectant  mother  has  such  a  constant  desire  to 
urinate  during  the  early  weeks  of  pregnancy,  before  the 
uterus  pushes  up  into  the  abdomen,  and  also  during  the 
later  weeks,  as  well  as  during  labor,  when  the  bladder  is 
being  pressed  upon  by  the  baby's  head. 

The  Rectum.  In  the  same  picture  you  will  see  the  rec- 
tum which  lies  just  behind  the  uterus  and  vagina  and  which 
terminates  in  the  anus.  Between  the  rectum  and  the  vagina 
is  a  thick  triangulai-  mass  of  muscle,  called  tlie  perineum, 
which  practically  forms  a  fioor  to  the  pelvis,  the  bony  basin 
without  a  bottom. 

The  external  genitalia,  sometimes  called  the  vulva, 
really  have  nothing  to  do  with  the  creation  of  the  baby,  but 


28  GETTING  READY  TO  BE  A  MOTHER 

you  will  better  understand  some  of  the  care  that  is  given 
you  if  you  know  a  little  about  them,  too.  Between  the 
thighs,  where  they  join  the  body,  are  two  thick  folds  of  flesh, 
called  the  labia  and  between  these  lie  the  perineum,  just 
mentioned,  and  the  openings  from  the  rectum,  vagina  and 
bladder  as  shown  in  Fig.  2. 

Now  that  w^e  have  something  of  an  idea  of  the  structure 
of  the  organs  concerned  with  tlie  creation  of  the  baby,  we 
shall  want  to  learn  about  the  usual  activities  of  these  in- 
teresting little  parts,  before  the  baby  begins  his  life  within 
them. 

Puberty  or  Adolescence.  You  know,  of  course,  that  girls 
are  incapable  of  becoming  mothers  until  after  what  is 
termed  puberty,  or  adolescence,  and  by  these  terms  we 
mean  the  period  during  which  childhood  develops  into 
sexual  maturity,  and  the  individual  becomes  capable  of  re- 
production. The  age  at  which  puberty  occurs  varies  with 
climate,  race  and  occupation  and  with  different  individ- 
uals of  the  same  status.  But  the  average  for  girls,  in  tem- 
perate climates,  is  from  the  twelfth  to  the  sixteenth  year 
and  for  boys  from  the  fourteenth  to  the  seventeenth  year. 
Girls  in  southern  climates  sometimes  mature  as  early  as  the 
eighth  or  ninth  year  while  in  colder  regions  puberty 
may  be  delayed  until  they  are  eighteen  or  twenty  years 
old. 

The  occurrence  of  puberty  marks  the  establishment  of 
ovulation  and  menstruation,  tAvo  functions  which  are  usu- 
ally performed  once  a  month  during  the  ehildbearing 
period. 

Ovulation,  which  probably-  occurs  abovit  midway  between 
the  menstrual  periods,  is  simply  the  name  which  has  been 
given  to  the  principal  function  of  the  ovary  and  may  be 
defined  as  the  development  of  the  ovum,  or  egg,  and  its  ex- 
pulsion, when  mature,  from  the  ovary.     As  the  entire  hu- 


WHERE  THE  BABY'S  LIFE  BEGINS  29 

man  body  has  its  origin  in  this  tiny  ovum,  its  career  and 
course  of  development  are  of  momentous  importance  to 
us,  and  at  the  same  time  furnish  a  tah-  of  ahsorl)ing:  in- 
terest. The  ovaries  ai'c  i)acke(l  full  of  these  tiny  egg-like 
cells,  which  probably  lie  dormanl,  as  stated  before,  until 
the  girl  reaches  ])ubei'ty.  Then  tiiey  begin  to  develop  and 
grow  and  push  their  way  fi'om  the  inside  of  the  ovary  to 
the  surface  where  they  look  more  or  less  like  blisters.  When 
an  ovum  reaches  the  sui'face  of  the  ovary,  a  thin  membrane 
which  contains  it,  bursts,  and  it  is  suddenly  expelled  into 
the  abdominal  cavity.  You  will  remember  that  the  ovary  is 
very  near  the  funnel-like  end  of  the  tube,  so.  when  the  little 
cell  is  shot  out  of  the  ovary,  it  finds  itself  floating  around 
quite  close  to  this  wide  opening.  Some  of  the  ova  that  are 
projected  into  the  abdominal  cavity  are  doubtless  lost,  but 
others  find  their  way  into  the  near-by  mouth  of  the  tube, 
and  if  not  fertilized  by  uniting  with  a  male  cell,  wiiich  w^e 
shall  explain  presently,  they  i)ass  down  the  tube  into  the 
uterus  and  are  finally  carried  out  in  the  menstrual  flow.  It 
is  probable  that  as  a  rule  only  one  ovum  ripens  and  es- 
capes from  the  ovary  each  month  from  puberty  until  the 
menopause  or  change  of  life. 

The  interesting  thing  al)out  all  of  this  is  that  each  time 
an  ovum  does  mature  and  is  discharged  from  the  ovary, 
the  lining  of  the  uterus  becomes  thicker  and  softer  in  order 
to  facilitate  the  attachment  of  the  ovum,  if  it  is  fertilized, 
this  attachment  being  necessary  if  a  baby  is  to  develop. 
This  preparation  of  the  utei-ine  lining  is  often,  and  very 
appropriately,  referred  to  as  "nest-building." 

Menstruation,  which  is  the  evidence  of  sexual  maturity, 
is  a  monthly  hemorrhage  from  the  uterus,  escaping  through 
the  vagina,  and  it  normally  i-ecurs  regularly  throughout  the 
child-bearing  period,  except  during  pregnancy  and  while 
the  young  mother  nurses  her  baby.    The  length  of  this  child- 

THF    PAPFCIP    r»r»/IOT    indnatii 


30         GETTING  READY  TO  BE  A  MOTHER 

bearing  period  is  about  thirty  years  and  continues  from 
puberty  until  the  menopause.  The  frequency  of  the  men- 
strual periods  varies  from  twenty-one  to  thirty  days  but 
the  normal  interval  between  periods  is  tw^enty-eight  days, 
which  is  the  length  of  what  is  called  the  ' '  menstrual  cycle. ' ' 
Thus  it  is  usually  a  lunar  month  from  the  beginning  of  one 
period  to  the  next  one,  making  thirteen  menstrual  periods 
during  each  calendar  year.  The  complete  course  of  a  men- 
strual cycle  consists  of  four  stages,  which,  it  is  believed, 
occur  somewhat  as  follows : 

The  first,  or  constructive  stage,  lasts  about  seven  days. 
It  is  during  this  stage  that  the  preparations  are  made  to 
receive  the  ovum  traveling  down  the  tube.  The  entire 
uterus  becomes  congested  with  blood  and  is  somewhat  en- 
larged and  softened  as  a  result,  while  its  lining  grows  red, 
thick  and  velvety.  If  the  ovum  remains  unfertilized,  which 
is  usually  the  case,  it  does  not  attach  itself  to  this  elabo- 
rately prepared  lining,  but  passes  out  with  the  uterine  dis- 
charges and  all  of  this  preparation  not  only  goes  for 
naught  but  must  be  undone. 

The  second  stage,  therefore,  which  lasts  about  five  days, 
is  the  destructive  stage  and  is  the  period  we  speak  of  as 
menstruation.  During  this  period  the  extra  tissue 
which  has  been  formed  in  the  uterus  is  broken  down ;  it 
mixes  with  the  blood  that  oozes  from  the  congested  lining 
and  together  they  pour  from  the  vagina  as  the  menstrual 
flow. 

The  third  or  reparative  stage,  which  follows,  occupies 
about  three  days  during  which  time  the  uterus  and  its  lin- 
ing return  to  their  normal  state. 

The  fourth,  or  quiescent  stage,  now  follows  and  lasts 
twelve  or  fourteen  days.  This  is  the  time  remaining  before 
Nature,  with  unwearying  patience,  begins  all  over  again  to 
prepare  for  the  reception  and  attachment  of  the  next  ma- 


WHERE  THE  BABYS  IJFE  BEGINS  M 

tiircd  ovum,  in  case  of  its  possiblo  fertilization.     And  so 
it  goes,  month  after  month  and  year  after  year. 

It  is  very  important  for  a  woman  who  is  suffering  from 
painful  menstruation  to  consult  a  doctor  about  correcting 
the  cause,  in  the  interests  of  her  future  child-bearing,  if 
for  no  other  reason,  for  this  is  one  step  toward  preparing 
a  good  soil  in  which  to  plant  the  seed  from  which  a  baby 
may  grow\  For  example,  a  misplacement  of  the  uterus  i 
a  frequent  cause  of  painful  menstruation  and  if  it  re- 
mains uncorrected  may  make  conception  impossible;  or  if 
conception  perchance  does  take  place,  the  malposition  of 
the  uterus  may,  later,  be  the  cause  of  an  abortion  or  mis- 
carriage. Inflammation  of  the  lining  of  the  uterus  is  an- 
other cause  of  menstrual  difficulty  and  if  allowed  to  persist, 
may  interfere  later  on  with  the  normal  development  and 
nourishment  of  the  baby. 

The  menopause,  also  termed  the  climacteric,  or  the 
change  of  life,  marks  the  permanent  stopping  of  menstrua- 
tion and  ability  to  bear  children.  This  ordinarily  occurs 
betW'Cen  the  ages  of  forty  and  fifty,  the  majority  of  women 
ceasing  to  menstruate  during  their  forty-sixth  year. 

The  most  favorable  age  for  motherhood  to  begin  is  a  sub- 
ject of  considerable  interest  to  most  women.  When  it  is 
considered  from  all  standpoints,  social,  ethical,  spiritual  as 
well  as  physical,  the  most  favorable  age  for  motherhood 
to  begin  seems  to  be  sometime  in  the  early  twenties.  Chil- 
dren have  been  born  to  little  girls  nine  years  old  and  to 
women  over  sixty,  but  the  extremes  of  the  reproductive 
years  are  not  favorable  periods  for  child-bearing. 

Now  a  word  about  the  breasts.  Tliej'  appear  to  be 
merelj^  large,  soft  masses  of  fat,  one  on  each  side  of  the 
chest,  having  no  connection  with  the  pelvic  organs.  But  in 
reality  they  are  very  complicated  glands  and  strangely 
enough,  though  no  one  knows  why,  their  activities  are  con- 


32 


GETTING  READY  TO  BE  A  MOTHER 


trolled  by  the  activities  of  the  generative  organs  down 
in  the  pelvis.  Certain  it  is  that  their  function  is  very  im- 
portant to  the  baby,  for  the  breasts  are  the  factories  in 
which  nourishment  is  produced  to  nourish  him  during  the 
first  few  months  after  he  is  born. 

If  we  could  look  inside  of  the  breasts  we  should  see  that 
in  structure  they  are  much  like  several  clusters  of  grapes 


Fig.  5. — Front  view  of  breast,  showing  areola ;   openings  from  milk 
ducts  and  the  glands  beneath  the  skin. 


in  which  the  stems  and  grapes  are  hollow.  The  milk  is 
formed  in  the  tiny  sacs  corresponding  to  the  grapes,  and 
pours  into  the  little  tubes  conforming  to  the  stems;  these 
empty  into  a  central  tube,  opening  upon  the  surface  of  the 
nipple  from  which  the  baby  will  extract  his  nourishment. 
If  you  will  look  at  Fig.  5  you  will  see  in  that  picture  of  the 
front  of  a  breast,  that  a  part  of  it  apparently  has  been 
magnified  to  show  these  openings  of  the  milk  ducts.    There 


WHERE  THE  BABY'S  LIFE  BEGINS  33 

are  about  fifteen  or  twenty  of  them  in  each  nipple.  The 
picture  shows  also  the  little  frlaiuls  which  appear  as  small 
lumps  under  the  skin  ai-onnd  the  nipple,  both  in  the  dark 
circle  called  the  (inula  and  in  the  white  skin  surround- 
ing it. 

Summing  up  this  chapter  briefly,  we  find  that  the  pelvis 
is  an  irregular,  bony  canal  or  l)asin,  drawn  in  about  the 
middle,  thus  forminjr  the  ui)i)er,  or  false  pelvis  and  lower 
or  true  pelvis,  neither  of  which  has  a  bottom.  The  open- 
ing between  these  two  basins  is  called  the  inlet,  while  the 
low^er  margin  of  the  true  pelvis  is  called  the  outlet,  but 
it  is  the  inlet  that  is  of  particular  importance  during 
child-birth.  In  the  center  of  tlic  lower  pelvis  and  swung 
upon  ligaments  attached  to  its  sides  is  the  uterus,  whose 
lower  part,  called  the  cervix,  extends  downward  into  the 
vagina ;  while  reaching  out  from  the  upper  corners  of  the 
uterus  are  tlie  tubes,  and  near  their  open  ends,  one  on  each 
side,  are  the  ovaries  filled  with  germ  cells  called  ova.  The 
bladder  lies  in  front  of  the  uterus  and  vagina  and  the  rec- 
tum behind,  while  below  is  the  perineum,  forming  a  flqor  to 
the  pelvic  cavity.  Every  four  weeks  during  the  child- 
bearing  years  an  ovum  is  expelled  from  one  of  the  ovaries 
into  the  abdominal  cavity  and  the  uterus  regularly  pre- 
pares to  receive  it  in  case  of  its  fertilization,  but  if  it  is 
not  fertilized  the  ovum  is  lost  and  menstruation  occurs. 

We  see,  too,  that  although  the  breasts  are  situated  re- 
motely from  the  pelvic  organs  thej'  are  really  very  im- 
portant accessories,  since  they  provide  milk  to  nourish  the 
baby  after  his  life  within  the  uterus  is  terminated  by  his 
birth. 


CHAPTER  IV 
HOW  THE  BABY  DEVELOPS  BEFORE  HE  IS  BORN 

Now  that  we  know  something  of  the  place  where  the 
baby's  life  begins  and  how  the  way  is  prepared  for  his 
growth,  we  are  ready  to  follow  the  interesting  course  of 
events  that  occur  from  the  time  the  seed,  a  tiny  egg-like 
cell,  bursts  from  an  ovary  until  the  beautiful,  fully  de- 
veloped baby  comes  into  the  world. 

You  will  remember  that  Avhen  the  ovum  is  expelled  from 
an  ovary  it  may  float  about  in  the  abdominal  cavity  and  be 
lost  or  it  may  enter  the  near-by  mouth  of  a  tube.  Also 
that  if  it  enters  a  tube  it  is  carried  downward  tow^ard 
the  uterine  cavity  by  the  sweeping  motion  of  the  hair-like 
projections  on  the  lining  of  the  tube.  This  journey  of  the 
ovum  through  the  tube  is  of  enormous  consequence,  for  dur- 
ing its  course  occur  the  events  which  decide  whether  the 
ovum  shall,  like  most  of  its  fellows,  be  simply  swept  along 
to  no  end  and  lost,  or  whether  by  chance  it  is  to  receive 
the  mysterious  impulse  which  begins  the  development  of  a 
new  human  being.  The  amazing  power  which  enables  this 
cell  to  reproduce  itself,  and  to  develop  with  unbelievable 
complexity  is  acquired  somewhere  in  the  tube,  usually  in 
the  upper  end,  by  meeting  and  fusing  with  a  sperma- 
tozoon, the  germinal  cell  of  the  male. 

The  spermatozoa  are  attracted  to  the  ovum  much  as 
bits  of  metal  are  drawn  to  a  magnet,  but  although  the 
ovum  that  is  destined  to  be  fertilized  is  surrounded  by 
several  spermatozoa,  only  one  actually  enters  and  fuses 
with  it. 

34 


HOW  BAIiY  DP]VKL()1»S  l>,P]FORE  BIRTH        :r) 

This  fusion  is  termed  fertilization,  or,  in  lay  i)arlanee, 
conception,  and  the  instant  at  which  it  occurs  marks  the 
beginning'  of  pregnancy.  The  establishment  of  this  fact 
is  of  considerable  importance,  since  it  does  away  with 
any  possible  controversy  concerning  tlie  time  at  which  a 
new  life  begins.  The  origin  of  the  baby  is  exactly  coinci- 
dent with  the  fusion  of  the  male  and  female  cells.  Fur- 
thermore, the  sex  of  the  cliild  and  any  inherited  traits  and 
characteristics  are  also  established  at  this  decisive  moment. 
No  amount  of  dieting,  exercise  or  mental  effort  on  the  part 
of  the  expectant  mother  can  alter  or  influence  them  in  the 
smallest  degree,  for  the  father  has  made  his  complete  contri- 
bution toward  the  creation  of  the  new  being  and  the 
mother,  also,  has  made  hers,  except  for  nourishment  which 
she  provides  throughout  pregnancy. 

All  told,  probably  more  than  five  hundred  theories  have 
been  advanced  to  explain  -what  it  is  that  decides  of  which 
sex  the  forthcoming  child  is  going  to  be.  But  as  the  results 
of  applying  these  theories  have  scarcely  borne  out  the 
claims  of  their  advocates,  they  are  given  but  scant  attention 
to-day. 

The  present  belief  regarding  the  causation  of  sex  is  that 
although  there  is  but  one  kind  of  ovum,  there  are  two 
kinds  of  spermatozoa,  one  capable  of  producing  a  male 
and  the  other  a  female  child,  but  the  sex-determining  form 
of  the  male  cell  that  fertilizes  any  one  ovum  is  a  matter 
of  the  merest  chance.  Statistics  shoAv  that  more  male  than 
female  babies  are  born,  the  usual  proportion  being  about 
105  boys  to  100  girls  among  those  who  are  carried  to 
"term"  or  the  end  of  pregnancy.  Among  abortions  and 
prematurely  born  babies  there  is  also  a  larger  number  of 
boys  than  girls,  but  as  more  boj's  than  girls  die  in  infancy, 
the  two  sexes  about  even  up  in  the  number  of  those  living 
to  adult  life. 


36 


GETTING  READY  TO  BE  A  MOTHER 


Concerning  the  time  of  the  month  when  conception  is 
most  likely  to  occur,  there  is  a  wide  difference  of  opinion. 
Some  doctors  think  that  the  most  favorable  period  is  just 
before  or  just  after  menstruation,  while  others  believe  that 
conception  is  most  likely  to  take  place  about  midway  be- 
tween the  menstrual  periods. 

Returning  to  the  ovum  which  meets  a  spermatozoon  in 
the  course  of  its  journey  down  the  tube,  Wc  find  that  as 


Latev  staceS    of   ceU    division. 

Fig.  6. — Diagram  indicating  process  of  cell  division. 

soon  as  a  spermatozoon  enters  an  ovum  it  disappears  and  is 
completely  absorbed,  and,  as  the  ovum  in  turn  is  instantly 
possessed  of  new  powers,  through  the  presence  of  the  male 
cell,  the  result  of  this  union  is  an  entirely  new  cell.  But 
instead  of  continuing  its  existence  as  a  single  cell,  the  fertil- 
ized ovum  divides  into  two  cells ;  these  two  into  four ;  the 
four  into  eight  and  so  on  until  a  clustering  mass  of  cells  is 
formed  which  looks  something  like  a  mulberry.  If  you  will 
look  at  Fig.  6  you  will  see  what  happens  as  this  cell  division 
progresses  and  also  that  in  time  the  cells  rearrange  them- 
selves in  such  a  way  as  to  leave  a  space  in  the  center  of  the 


now  I'.Ai'.v  I)i:\'i:l()I's  p.kkoi;!-;  iiiiri'ii       wi 

mass  so  that  it  becojiics  a  little  sac  with  a  cliistcr  ol'  cells  at 
one  point,  which  liaii<,'s  toward  the  center,  called  tiie  internal 
cell  mass.  This  will  interest  yon  becanse  it  is  from  cells  at 
one  point  in  this  little  cluster  that  the  baby  begins  to  de- 
velop, together  with  the  cord,  bag  of  waters  and  after- 
birth, to  be  described  later. 

While  these  changes  are  taking  place,  the  entire  mass  is 
being  carried  slowly  down  the  tnbe  toward  the  nterus  by 
the  sweeping  motion  of  tiic  soft  little  hairs  on  the  lining 
of  the  tube.  It  is  steadily  growing,  and  by  the  time  it 
reaches  the  uterus  the  mass  is  about  the  size  of  the  head 
of  a  pin.  As  you  will  remember,  the  lining  of  the  uterus 
prepares  each  month  to  receive  the  fertilized  ovum,  becom- 
ing soft  and  thick.  The  cell  mass  floats  around  for  a  little 
while  after  it  reaches  the  uterine  cavity  and  then  resting  at 
some  point,  sinks  down  into  the  soft  lining  and  is  completely 
buried. 

From  now  on  the  cells  which  compose  the  mass  rapidly 
increase  in  number  and  very  shortly  cease  to  be  all  of  one 
kind.  These  different  kinds  of  cells  rearrange  themselves 
and  grow  in  such  a  manner  that  some  of  them  begin  to 
form  the  different  parts  of  the  baby's  body  and  others 
develop  into  two  thin  membranes  that  finally  enclose  the 
baby  in  a  double  sac.  lie  is  attached  to  the  inner  surface 
of  the  sac ;  the  space  which  he  does  not  occupy  is  filled  with 
fluid  and  the  sac  itself  is  attached  to  the  uterine  lining  at 
the  point  where  the  cell  mass  happened  to  stop  and  bury 
itself. 

This  sac  is  what  you  have  heard  called  the  "bag  of 
waters,"  but  the  doctors  refer  to  it  as  the  membranes. 
As  it  enlarges  and  pushes  out  into  the  uterine  cavity  it  still 
consists  of  two  thin  membranes  except  where  it  is  attached 
to  the  uterus,  at  which  point  it  grows  into  a  thick,  spongy 
mass    of    blood-vessels.      These    blood-vessels    divide    and 


38 


GETTING  READY  TO  BE  A  MOTHER 


branch  out  in  a  tree-like  fashion  and  burrow  into  the 
uterine  wall.  As  you  will  see  later,  it  is  through  this  mass 
of  branching  blood-vessels  that  the. baby  virtually  eats  and 
breathes  and  gives  off  waste  materials  during  the  nine 
months  of  his  life  within  the  uterus.     The  doctors  refer  to 


Tut^^^ 


c^-viTv 


Fig.  7. — Diagram  showing  the  developing  baby,  at  an  early  stage,  with 
cord,  membranes  and  placenta,  within  the  uterine  cavity. 


the  mass  as  the  placenta  but  you  have  heard  it  called  the 
"afterbirth,"  because  it  is  expelled  after  the  baby  is  born. 
As  the  baby's  development  advances  the  part  by  which 
he  is  connected  with  the  placenta  lengthens  out  into  what 
is  called  the  umbilical  cord.  There  are  blood-vessels  in 
this  cord  through  which  blood  constantly  flows  back  and 
forth,  carrving  nourishment  to  the  baby  from  his  mother 


now  i5Anv  DKVKivors  i'.ki-'oiji-:  luirni      ;{!) 

and  waste  matter  from  his  little  body  to  the  plaeenta  where 
it  is  taken  up  by  her  blood.  I>iit  this  exehaiifre  of  materials 
takes  place  tiiroufjh  tiiiii  )iiembraiies  and  eonsequently  the 
blood  of  the  mother  and  baby  never  mingle.  Fig.  7  will 
give  yon  an  idea  of  how  the  sae  of  membranes,  with  the  baby 
hanging  inside,  grows  out  into  the  uterine  cavity;  how  at 
the  point  where  the  membi-aiu's  are  attached  to  the  uterus 
the  blood-vessels  lia\e  develoi)ed  into  the  thick,  spongy 
placenta  and  liow  the  baby  is  connected  with  it  by  means 
of  the  cord,  in  Fig.  S  yon  nuiy  see  how  the  baby  changes 
in  ajipearaiu-e  as  the  weeks  of  ])regnancy  go  by.  At  the  end 
of  the  fourth  month  he  I'cally  looks  (|uite  like  the  baby  that 
we  are  so  eagerly  preparing  for. 

If  we  follow  his  development  within  the  uterus  month 
by  month,  we  fiiul  that  by  the  end  of  the  first  lunar  month, 
or  fourth  week,  the  bal)y's  body  is  about  i/.  inch  long  and 
looks  about  as  is  suggested  in  the  third  little  outline  in 
Fig.  8. 

At  the  end  of  the  second  month,  or  eighth  week,  his 
head  is  fairly  well  shaped;  bones  are  beginning  to  develop, 
webbed  hands  and  feet  are  formed  and  the  little  body  is 
about  1  inch  long. 

At  the  end  of  the  third  month,  or  twelfth  week,  his 
entire  body  shows  mai-ked  development  and  is  about  31/2 
inches  long.  His  fingers  and  toes  are  separated  and  bear 
soft  nails ;  the  teeth  are  fonning,  the  eyes  have  lids  and  the 
umbilical  cord  has  taken  definite  form. 

At  the  end  of  the  fourth  month,  or  sixteenth  week,  in 
addition  to  the  development  of  all  parts  a  fine,  soft  hair 
appears  over  the  body;  there  is  a  black,  tarry  substance, 
called  meconium,  in  the  I)ab\'s  intestines  and  he  measures 
about  6  inches  in  length  and  weighs  perhaps  1/4  pound. 

By  the  end  of  the  fifth  month,  or  twentieth  week,  the 
baby  lias  grown  and  developed  mai'kedly.     lie  is  now  cov- 


40 


GETTING  READY  TO  BE  A  MOTHER 


w-  '-' 


w  So 


5H 


P. 


HOW  HAIiV  DKVKLOI'S  I'.KKOliK  lilKTII        41 

ered  with  skin  on  which  are  occasional  patches  ol'  a  greasy, 
cheesy  substance  called  vernix  caseusa,  and  though  there  is 
some  fat  beneath  the  skin  his  face  looks  old  and  wrinkled. 
A  certain  amount  of  hair  has  appeared  upon  the  head  and 
the  eyelids  are  opening.  It  is  usually  during  the  fifth 
month  that  the  expectant  mother  first  feels  her  baby  move, 
this  sensation  being  commonly  referred  to  as  "quickening." 
He  is  now  about  10  inches  long  and  weighs  about  H  nnnces. 

By  the  end  of  the  sixth  month  or  twenty-fourth  week, 
the  baby  is  about  VI  inches  long  and  weighs  possibly  II/2 
pounds.  He  is  thin  and  wrinkled  in  appearance  and  if  born 
at  this  time  will  attempt  to  breathe  and  move  his  limbs  but 
will  perish  in  a  short  time. 

By  the  end  of  the  seventh  month,  or  twenty-eighth 
week,  he  still  looks  thin  and  scrawny;  his  skin  is  reddisli 
and  is  well  covered  with  the  cheesy  vernix  caseosa.  If  born 
at  this  stage,  the  baby  will  move  quite  vigorously  and  cry 
feebly,  but  he  is  not  likely  to  live  for  any  length  of  time. 
He  is  now  about  l-t  inches  long  and  weighs  about  2% 
pounds. 

By  the  end  of  the  eighth  month,  or  thirty-second  week, 
the  baby  has  grown  to  about  17  inciies  in  length  and  -4 
pounds  in  weight,  but  continues  to  look  thin  and  old  and 
wrinkled.  His  nails  do  not  extend  beyond  the  ends  of  his 
fingers  but  are  firmer  in  texture ;  the  soft,  downy  hair  begins 
to  disappear  from  his  face  but  the  hair  on  his  head  is  more 
abundant.  If  born  at  this  stage,  the  ])aby  will  have  a  fair 
chance  to  live,  provided  he  is  given  painstaking  care.  This 
is  true  in  spite  of  the  old  belief,  still  widely  current,  that  a 
seven  months'  baby  is  more  likely  to  live  than  one  born  at 
eight  months  (meaning  calendar  months).  The  fact  is  that 
after  the  twenty-eighth  week  the  i)rol)ability  of  the  baby's 
living  increases  greatly  with  each  added  week  of  life  within 
the  uterus.    His  growth  during  the  latter  part  of  pregnancy 


42 


GETTING  READV  TO  BE  A  MOTHER 


is  rapid,  for  he  gains  nine  tenths  of  his  weight  after  the  fifth 
month  and  one  half  of  liis  weight  during  the  last  eight 
weeks  of  uterine  life. 

At  the  end.  of  the  ninth  month,  or  thirty-sixth  week, 
the  increased  amount  of  fat  under  the  baby's  skin  has  given 
a  plumper,  rounder  contour  to  the  entire  body;  the  aged 


Uterine   ^^^':>'<^^^ 


Pi  a  cent 


CoydL 


VJtertn 
External 

Fig.  9. — The  usual  position  of  the  baby  just  before  he  is  born. 


look  has  passed  and  his  chances  for  life  have  greatly  in- 
creased. He  weighs  about  5I/2  pounds  at  this  stage  and  is 
perhaps  18  inches  long. 

The  end  of  the  tenth  month,  or  fortieth  week,  usually 
marks  the  end  of  pregnancy.  Fig.  9  will  show  ,you  liow  the 
baby  lies  in  the  uterus  just  before  birth,  curled  up  into  the 
smallest  possible  space. 


now  liAin'  i)i:\KL()i»s  ijkkoi^k  I'.iirrii      4;{ 

The  average  iionnally  devdojx'd  Itahy  lias  grown  to  a 
length  of  about  20  inches  and  weighs  about  7V4  l)'>uiids, 
bo^'S  usually  being  about  three  ounces  lieavier  than  gii'ls, 
but  there  may  be  a  variation  of  weight  among  entirely 
normal,  healthy  babies  from  a  minimum  of  5  pounds  to  as 
high  as  11  pounds  or  more.  Newborn  l)abies  very  seldom 
weigh  more  tiian  12  pounds,  in  spite  ol'  h'gends  and  rumors 
to  the  contrary. 

The  size  of  the  baby  is  affected  by  the  race  of  his  parents ; 
colored  babies/for  example,  averaging  a  smaller  weight  than 
white  babies.  And,  as  might  be  expected,  the  size  of  the 
parents  is  likely  to  be  reflected  in  their  infants,  large  par- 
ents tending  to  have  large  children  and  vice  versa. 

The  number  of  children  which  the  mother  has  previously 
borne  is  also  a  factor,  since  the  first  child  is  usually  the 
smallest,  the  size  of  those  followdng  showing  an  increase  with 
the  mother's  age  up  to  her  twenty-eighth  year,  if  her  preg- 
nancies do  not  occur  at  too  frequent  intervals. 

Twins.  Sometimes  a  woman  gives  birth  to  more  than 
one  baby  at  the  same  time.  When  there  are  two  they  are 
called  twins ;  triplets  when  there  are  three ;  quadruplets, 
quintuplets  and  sextuplets  respectively,  when  there  are 
four,  five  and  six  babies  within  the  uterus  at  once.  Six 
is  the  largest  accredited  number  on  record. 

It  is  estimated  that  twins  occur  once  in  ninety  preg- 
nancies and  triplets  once  in  about  seven  thousand  cases. 
The  tendency  seems  to  be  inherited,  as  is  evidenced  by  the 
number  of  twins  and  triplets  to  be  found  among  relatives. 

Twins  are  often  prematurely  born  and  each  is  likely  to 
be  smaller  than  a  baby  resulting  from  a  single  pregnancy, 
but  their  combined  weight  is  greater  than  the  weight  of  one 
normal  baby. 

Extra-Uterine  Pregnancy.  Another  departure  from  the 
normal  pregnancy  is  when  the  baby  develops  outside  of  the 


44    GETTING  READV  TO  BE  A  MOTHER 

uterus.  Although  in  the  normal  course  of  events  the  fer- 
tilized ovum  travels  down  the  tube  and  becomes  attached 
to  the  uterine  lining,  it  is  possible  for  it  to  stop,  and 
more  or  less  completely  develop  at  any  point  along  the 
way.  This  is  called  an  extra-uterine  pregnancy,  since  it 
occurs  outside  of  the  uterus.  If  the  baby  develops  in  one 
of  the  ovaries,  it  is  termed  an  ovarian  pregnancy,  and  a 
tubal  pregnancy  if  it  develops  in  a  tube,  this  being  the  most 
frequent  variety  of  extra-nterine  pregnancies.  Only  about 
one  out  of  a  hundred  such  pregnancies  continue  throughout 
the  allotted  period,  and  accordingly,  a  live  baby,  capable  of 
living  for  any  length  of  time,  seldom  results. 

To  sum  up  a  normal  pregnancy,  we  find  that  in  the  course 
of  ten  lunar  months  following  the  fertilization  of  an  ovum, 
the  uterus  grows  from  a  small,  flattened  pelvic  organ,  3 
inches  in  length,  to  a  large  muscular  sac,  about  15  inches 
long  occupying  the  abdominal  cavity.  It  increases  its  weight 
sixteen  times,  that  is,  from  2  ounces  to  2  pounds,  while 
the  capacity  of  the  uterine  cavity  is  multiplied  five  hundred 
times.  Within  the  uterus  is  a  baby  weighing  about  7I/4 
pounds;  a  placenta  weighing  perhaps  ly^  pounds  and  ap- 
proximately- a  quart  of  fluid.  The  baby  is  attached  to  the 
placenta  by  means  of  a  jelly-like  cord  about  as  thick  as 
one's  first  finger  and  20  inches  long;  baby,  placenta,  cord 
and  fluid  all  being  contained  in  a  thin,  but  strong  sac  fre- 
quently called  the  bag  of  waters,  but  by  the  doctors  termed 
the  membranes.  The  total  weight  of  the  uterus  and  its 
contents  at  the  end  of  pregnancy  is  usually  about  15 
pounds. 

Throughout  the  baby's  life  within  the  uterus,  the  placenta 
virtually  acts  as  his  digestive  organs,  lungs,  kidne.ys  and 
bowels.  Bear  this  in  mind,  and  you  will  realize  why,  in 
taking  care  of  yourself  you  are  taking  care  of  your  baby 
while  his  body  is  being  built  and  getting  itself  into  running 


HOW  BABY  DEVELOI'S  I'.KFORH  P.IRTII        45 

order  to  take  up  lit'c  as  a  separate  l)ein<r.  The  full  realiza- 
tion that  Avhatevor  is  «>'0()(1  for  you  is  <;oo(l  for  your  baby 
will  make  you  eager  to  give  yourself  the  eare  that  is  out- 
lined in  the  next  chapter. 


CHAPTER  V 
TAKING  CARE  OF  THE  BABY  BEFORE  HE  COMES 

We  shall  see  that  taking-  care  of  your  baby  before  he 
is  born  means  taking-  surh  care  of  yourself  throughout 
pregnancy,  that  you  not  only  keep  your  own  body  in  its 
usual  good  running  order,  but  in  addition,  so  effectively 
promote  the  activities  of  your  various  organs  that  you 
also  keep  the  baby's  body  going,  his  body  that  is  grow- 
ing all  the  time. 

Quite  reasonably  this  requires  extra  work  on  the  part 
of  some  of  your  organs,  particularly  those  concerned  with 
digestion  and  the  process  of  throwing  off  impurities.  The 
latter  is  of  the  greatest  possible  importance  for  in  addition 
to  excreting  the  usual  amount  of  impurities  from  your  own 
body  you  must  excrete  also  those  thrown  off'  by  your  baby. 
The  amount  of  waste  from  him  is  not  large  but  it  seems 
to  be  of  such  a  character  that  it  harms  the  mother  if  it  is 
not  steadily  excreted. 

Good  digestion  and  satisfactory  excretion  are  dependent 
upon  a  number  of  factors  and  fortunately  most  of  them 
are  wdthin  your  own  control. 

Your  frame  of  mind  is  one  of  the  most  important  factors 
of  all.  I  know  that  to  suggest  the  cultivation  of  a  cheerful, 
hopeful  mental  attitude  is  easier  said  than  done.  But 
after  all  it  really  is  largely  a  matter  of  habit  which  you 
can  acquire  if  you  set  yourself  to  it,  particularly  if  you 
realize  that  your  physical  condition  will  be  benefited  by 
your  going  through  pregnancy  happily.  And  remember 
that  Avhatever  is  good  for  you  is  good  for  your  baby. 

40 


CARE  OF  Tiir:  I'.Ai;^'  i;h:K()i,"i';  iik  co.Miis    47 

Contiiiiic  with  the  work,  amusements  iiiid  exereise  that 
you  are  used  to  and  enjoy,  except  of  course  such  itetivities 
as  the  doctor  may  forbid.  In  jjjcncial,  try  to  forget  that 
you  are  pregnant,  so  far  as  you  can  (h)  this  and  still  re- 
member to  take  ])ropcr  cai'i*  of  yoni-sclf. 

Above  all,  don't  Mony.  Worry  will  iiilerfere  with  your 
sleep  and  it  will  also  upsci  your  digestion  quite  as  seri- 
ously as  will  wi'ong  food.  Tvy  not  to  Ix'  too  self-centered 
or  too  watchful  of  your  syinptoins,  hui  at  tiie  same  time 
avoid  the  dangerous  habit  of  thinking  that  any  unusual  con- 
dition which  develops  is  due  to  your  being  pregnant,  for  a 
sick  pregnancy  is  not  normal. 

It  will  relieve  you  of  a  great  deal  of  anxiety  if  you  report 
to  your  doctor  everything  you  do  not  understand,  for  the 
consciousness  that  he  will  know  just  what  to  do,  if  anything 
is  necessary,  will  help  to  keep  you  from  worrying. 

It  is  important,  too,  for  you  to  get  rid  of  the  depressing 
beliefs  in  connection  with  pregnancy  that  have  come  down 
to  us  through  the  ages. 

For  instance,  do  not  believe  for  a  moment  that  anything 
you  do,  think  or  see  can  "mark"  or  deform  your  baby,  for 
remember  that  after  conception  you  give  him  nothing  but 
nourishment.  The  only  communication  between  you  and 
the  baby  is  through  your  and  his  blood,  and  l)lood  does  not 
carry  mental  impressions.  Accordingly,  no  etfects  of  fear, 
horror  or  unpleasant  memories  which  you  may  have  can 
possibly  reaeli  him.  It  is  true  that  once  in  a  while  a  woman 
does  see  something  shocking  and  later  gives  l)irth  to  a 
marked  or  deformed  baby.  But  there  is  little  doubt, 
now,  that  such  an  occurrence  is  merely  a  coincidence.  If 
you  will  stop  and  think  for  a  moment  you  will  realize  that 
most  expectant  mothers  see  or  lieai-  or  think  something 
unpleasant  at  some  time  during  pregnancy,  and  yet  most 
babies  are  born  witliout  mark  or  blemish.     Anger,  fright 


48  GETTING  KEADY  TO  BE  A  MOTHER 

or  sudden  shock  may  upset  your  digestion,  but  it  does  not 
directly  affect  your  baby. 

As  for  that  common  belief  that  in  "reaching  up"  the 
mother  maj"  slip  the  cord  around  the  baby's  neck — if  yon 
will  picture  for  a  moment  liow  the  baby  lies  Avithin  the 
uterus  you  will  realize  how  impossible  this  is,  for  the 
mother's  arms  have  no  connection  with  hiin  or  the  cord. 

So  dismiss  tlieso  doubts  and  fears  from  your  mind  and 
dwell  instead  upon  the  loveliness  of  wliat  is  in  store  for 
you,  for,  I  repeat,  your  pliysical  condition  will  be  bene- 
fited if  you  go  through  pregnancy  happily.  And  remember 
again  that  whatever  is  good  for  you  is  good  for  your  baby. 

So  your  first  step  toward  caring  for  the  little  life  already 
within  your  charge  is  to  follow  the  example  of  Mrs.  Wiggs, 
who  constantly  wiped  the  dust  from  her  rose-colored  spec- 
tacles. 

Now  for  the  more  specific  details  of  your  care.  Of  these 
the  question  of  your  diet  is  of  enormous  importance. 

Let  us  consider  first  what  your  food  accomplishes  if  it 
is  suitable  and  conditions  are  favorable  for  its  use  by  you 
and  the  baby.  It  should  provide  nourishment  for  your 
various  tissues,  as  under  ordinary  conditions;  it  should 
promote  the  activities  of  your  skin  and  kidneys,  as  well 
as  bowels,  since  it  is  tlirough  them  tliat  the  waste  from 
your  own  and  your  baby 's  body  must  be  excreted,  and  your 
food  should  be  adequate  also,  to  build  and  nourish  the 
baby's  body  without  his  having  to  draw  materials  from 
your  tissues.  Strange  as  it  may  seem,  the  baby's  physical 
needs  are  supplied  before  yours  are  met,  and  if  there 
are  not  enough  food  materials  for  you  both,  your  bones, 
teeth  and  muscles  will  be  deprived.  Eurthermore,  taking 
proper  food  during  pregnancy  is  an  important  step  toward 
preparing  yourself  to  nurse  your  baby,  after  he  is  born, 
which  is  quite  as  urgent  as  nourishing  him  before  birth. 


CARE  OP  TIII^]  BABY  IJIOFOKK  11 H  COMES     49 

To  accomplish  these  ends  you  not  only  must  eat  suitable 
food,  but  you  must  difrest  and  absorb  it  as  well.  Tliis  re- 
quires that  you  constantly  gruard  a^rainst  overeating,  con- 
stipation and  indigestion  ot"  any  kind.  Indigestion  may  be 
avoided  during  pregnancy  exactly  as  it  is  at  other  times, 
by  eating  proper  food.  I)\'  cultivating  a  happy  frame  of 
mind;  by  having  sut^icicnl  c.xcrcise.  fresh  air,  rest  and 
sleep. 

If  you  are  accusioiucd  lo  a  fairly  sinii)lc,  well  balanced, 
mixed  diet,  you  probjibly  will  need  to  nuike  little  or  no 
change,  except  to  iuive  the  evening  meal  light  if  it  has  been  a 
hearty  one.  It  may  surprise  you  to  learn  that  you  need 
not  "eat  for  two,''  in  ((uautity.  as  is  so  commonly  believed 
necessary,  for  during  pregnancy  you  make  so  nuich  better 
use  of  food  materials  than  usual  that  an  amount  and  kind 
of  food  that  keep  you  in  good  condition  will  be  adequate  to 
meet  your  baby's  needs,  too.  until  the  latter  part  of  preg- 
nancy. On  the  other  hand,  it  is  very  unwise  for  an  expect- 
ant mother  to  cut  down  her  diet,  with  the  idea  of  keeping 
the  baby  snudl  and  thus  make  labor  easy,  except  under 
the  direction  of  her  doctor.  In  general  it  is  the  size  of  the 
baby's  head  that  makes  labor  easy  or  difficult,  and  not  the 
amount  of  fat  distributed  over  his  body.  And  if  the  mother 
cuts  down  the  miiu'rals  in  her  diet  to  make  the  baby  bones 
soft,  the  only  result  is  that  her  own  bones  and  teeth  are 
softened,  because  the  baby  extracts  from  them  enough  lime 
to  supply  what  the  food  lacks. 

Three  meals  a  day  will  usually  be  enough  during  at  least 
the  first  half  of  pregnancy  and  they  should  be  taken  with 
clock-like  regularity,  eaten  slowly  and  masticated  thor- 
oughly. The  possible  need  for  slight  additional  food  during 
the  later  weeks  may  be  supplied  more  satisfactorily  by 
lunches  of  milk,  cocoa  or  broth  and  crackers  or  toast,  be- 
tween meals  ;iiid  upon  retiring,  than  by  taking  larger  meals. 


50         GETTING  READY  TO  BE  A  MOTHER 

An  expectant  mother  who  has  a  tendency  to  nansea  early 
in  pregnancy  often  feels  better  for  taking  a  small  Innch 
regularly  five  or  six  times  daily  instead  of  the  usual  three 
full  meals. 

It  is  of  the  greatest  importance  that  every  pregnant  wom- 
an drink  an  abundance  of  fluid  to  act  as  a  solvent  for  her 
food  and  waste  material  and  promote  the  activity  of  her 
kidneys,  skin  and  bowels.  She  needs  about  three  quarts 
daily,  most  of  which  should  be  water,  the  remainder  consist- 
ing of  milk,  cocoa,  soup  and  other  liquids.  Alcohol  should 
not  be  taken  except  upon  the  doctor's  orders  and  only 
moderate  amounts  of  coffee  and  tea,  unless  he  gives  per- 
mission for  more. 

The  expectant  mother  will  be  wise  to  avoid  fried  food, 
pastry,  rich  desserts,  rich  salad  dressings  and  any  other  food 
which  would  ordinarily  disagree  with  her. 

Since  the  enjoyment  of  one's  meals  promotes  digestion 
at  all  times,  the  expectant  mother  should  try  to  eat  the 
things  that  she  enjoys  most  and  that  agree  with  her.  The 
average  pregnant  woman  who  has  no  symptoms  of  com- 
plications will  usually  be  able  to  supply  her  own  and  her 
baby's  needs  and  at  the  same  time  keep  within  the  bounds 
of  safety  if  she  selects  her  diet  from  the  foods  included 
in  the  following  groups  : 

Animal  Foods.  INIilk  and  eggs  are  the  most  satisfactory, 
but  for  the  sake  of  variety  and  to  tempt  her  appetite  the 
expectant  mother  will  usually  be  allowed  to  take  rather 
sparingly,  and  preferably  only  once  a  day,  of  fish,  the 
various  kinds  of  shell  fish,  beef,  lamb,  chicken  or  game. 
Pork,  veal  and  goose  should  be  avoided  as  a  rule,  and  par- 
ticularly by  women  with  whom  they  ordinarily  disagree. 

Soups.  Thin  soups  and  broths  have  little  food  value  but 
because  of  their  appetizing  flavor  and  aroma  are  an  aid 
to  digestion,  and  frequently  by  stimulating  a  flagging  appe- 


CARK  OF  TTTK  r.AliV  liKFOKP]  HE  COMES      51 

tite  ^vill  hell)  the  expectant  mother  to  eat  and  assimilate 
more  than  she  would  without  them.  But  eream  soups  and 
purees  have  a  hi^h  food  value  and,  like  thin  soui)s  and 
broths,  also  supply  a  definite  amount  of  fluid  which  she 
must  have. 

Vegetables.  The  group  of  vegetables  generally  desig- 
nated as  "leafy"  are  of  even  greater  importance  to  the 
expectant  mother  than  they  are  to  the  average  person.  Of 
these  she  may  safely  eat  onions,  asparagus,  celery,  string 
beans,  spinach,  and  she  should  make  a  point  of  taking  a 
green  salad,  such  as  lettuce,  cress  or  romaine,  at  least  once 
daily.  Sweet  potatoes,  white  potatoes,  rice,  peas,  Lima 
beans,  tomatoes,  beets  and  carrots,  also,  may  be  eaten  with 
safety,  as  a  rule,  but  cabbage,  cauliflower,  corn,  egg-plant, 
Brussels  sprouts,  parsnips,  cucumbers  and  radishes  should 
be  taken  with  gi*eat  caution  and  avoided  altogether  if  they 
cause  gas  or  any  kind  of  distress. 

Fresh  Fruits.  A  necessary  part  of  the  diet  is  fresh  fruit, 
and  among  those  fruits  which  are  both  beneficial  and  usu- 
ally harmless  are  ap])les,  peaches,  apricots,  }iears,  oranges, 
figs,  cherries,  pineapple,  grapes,  plums,  strawberries,  rasp- 
berries, blackberries  and  grapefruit.  These  are  more  likely 
to  be  laxative  if  eaten  alone,  as  before  breakfast  and  at  bed- 
time. Cooked  fruits  are  also  valuable  articles  of  diet,  but 
are  probably  less  laxative  than  raw  fruit.  Some  of  the 
citrous  fruits,  oranges,  grapefruit  or  lemons,  should  be 
taken  daily  because  they  i)0ssess  a  certain  indispensable 
food  value  Avhich  is  peculiar  to  them. 

Cereals.  For  their  nourishing  and  laxative  qualities, 
cereals  are  important  and  their  food  value  is  increased  by 
the  milk  and  cream  which  are  usually  taken  Avitli  them. 
Cooked  cereals  should  invariably  be  cooked  longer  than  the 
usual  directions  suggest.  Bran,  eaten  alone  as  a  cereal  or 
in  combination  with  other  grains,  is  an  excellent  laxative. 


52  GETTING  KEADY  TO  BE  A  MOTHER 

Breads.  Graham,  eoriimeal,  whole  wheat  and  bran  bread 
are  all  good,  in  general  the  expectant  mother  will  be  on 
the  safe  side  if  she  eats  sparingh',  if  at  all,  of  very  fresh 
or  hot  breads  and  hot  cakes. 

Desserts.  Desserts  are  very  important  for  they  add  to 
the  attractiveness  of  most  people's  meals,  and  if  wisely 
chosen  and  properly  made,  may  snppl}^  a  good  deal  of  easily 
digested  nonrishment.  They  may  include,  in  addition  to 
fresh  and  cooked  fruits  and  preserves,  ice-cream,  a  wide 
variety  of  custards,  creams  and  puddings  made  largely  of 
milk,  eggs  and  some  ingredient  to  give  substance  and  firm- 
ness, such  as  gelatin,  cornstarch,  rice,  tapioca,  farina,  ar- 
row-root and  similar  materials. 

In  general  the  expectant  mother  should  eat  an  abimdance 
of  fruit  and  vegetables,  taking  at  least  some  uncooked  fruit 
and  a  green  salad,  daily,  and  make  sure  that  her  food  con- 
tains a  good  deal  of  residue,  such  as  is  provided  by  fruit 
and  coarse  vegetables.  This  residue  increases  the  bulk  of 
the  material  in  the  intestines,  and  this  helps  to  overcome  the 
tendency  toward  constipation.  As  fat  is  less  easily  digested 
than  starchy  foods,  and  more  likely  to  cause  nausea  during 
pregnancy,  it  is  better  to  eat  no  more  fat  than  usual  but  to 
supply  the  additional  material  which  is  needed  after  about 
the  sixth  month,  by  taking  a  little  more  starchy  food.  How- 
ever, a  slight  increase  only  is  necessary,  and  this  chiefly 
during  the  last  three  or  four  weeks. 

The  Kidneys.  It  is  scarcely  possible  to  say  enough  about 
the  importance  of  keeping  your  kidneys  in  normal  working 
order  during  pregnancy,  for  through  them  is  excreted  much 
of  the  waste  matter  from  your  baby's  body  as  well  as 
your  own.  Sometimes  when  these  impurities  are  not 
thrown  off  as  they  should  be  the  expectant  mother  has  con- 
vulsions. You  will  be  glad  to  know  how  much  you  yourself 
can  do  toward  preventing  convulsions  l»y  drinking  plenty 


CARE  OF  TIIF.  BAliY  V.KFOliK   UK  COMES     53 

of  water  and  by  faillifully  measuring  ^-oiir  ui-ine  and  taking 
a  specimen  to  tlie  doctor  when  he  asks  you  to.  As  I  said 
before,  you  should  drink  at  least  three  quarts  of  tiuid  every 
(lay.  .Most  of  this  should  be  water,  the  remainder  being 
milk,  cocoa,  soup,  tea,  coffee,  and  so  on. 

The  doctor  will  probably  want  you  to  measure  your 
urine  and  take  a  specimen  to  liim  once  a  month  during  the 
first  half  of  pregnancy  and  every  two  weeks  afterward,  or 
even  every  week  toward  the  end.  lie  can  tell  by  examining 
the  urine  whether  your  kidneys  are  acting  as  they  should 
and  if  they  are  not  he  may  save  you  serious  trouble  by  put- 
ting you  to  bed  for  a  few  days  with  no  nourishment  but 
milk  and  water. 

In  preparing  a  specimen  you  will  need  a  covered  corked 
vessel  large  enough  to  hold  all  the  urine  passed  in  twenty- 
four  hours,  and  it  must  be  thoroughly  washed  and  scalded. 
The  next  step  is  to  pass  urine,  suppose  we  say  at  eight 
o'clock  in  the  morning,  and  throw  it  away.  All  of  the  urine 
which  you  pass  after  this  time  until  eight  o'clock  the  next 
morning  must  be  saved  in  the  vessel  and  kept  in  a  cool 
place  to  prevent  its  decomposing.  If  you  will  put  a  tea- 
spoonful  of  chloroform  or  boraeic  acid  powder  into  the  ves- 
sel it  will  tend  to  preserve  the  urine  and  will  not  injure 
the  specimen.  At  the  end  of  twenty-four  hours  the  urine 
should  be  shaken  to  mix  it  thoroughly  and  about  half  a 
pint  }K)ured  into  a  bottle  that  has  l)een  washed  and  scalded. 
Carefully  cork  and  label  this  with  the  date,  your  name 
and  address  and  the  total  amount  of  urine  passed  in  the 
twenty-four  hours.  The  vessel  for  collecting  the  urine  and 
whatever  you  use  as  a  measure  should  be  reserved  for  these 
purposes  only.  If  3'ou  have  no  tin  or  glass  measure,  a 
regular-size  quart  tomato  can  will  prove  entirely  satisfac- 
tory. 

If  you  find,  when  measuring  your  urine,  that  you  pass 


54  GETTING  KIOADV  TO  liE  A  MOTHER 

less  than  a  quart  and  a  half  in  twenty-four  hours,  you  may 
know  without  being  told  tliat  this  is  not  enough  and  that 
you  should  drink  more  water. 

The  Skin.  People  are  likely  to  think  of  the  skin  as  being 
simply  a  covering  for  the  body,  whereas,  in  reality,  it  is  a 
very  complicated  and  active  organ  which  helps  to  regulate 
the  body  temperature  and  constantly  throws  off  impurities, 
just  as  the  kidneys  do.  This  latter  function  is  performed 
by  the  sweat  glands  which  open  upon  the  surface  of  the 
skin  as  the  "pores,"  and  we  are  told  that  in  all  there  are 
some  twenty-eight  miles  of  these  tiny  tube-like  structures 
in  the  skin.  These  glands  should  be,  and  usually  are,  con- 
stantly active ;  they  pour  upon  tlie  surface  of  the  body  an 
oily  substance  which  keeps  the  skin  soft;  the}"  also  excrete 
something  more  than  a  pint  of  water  daily,  which  contains 
impurities  that  are  harmful  if  retained  in  the  body.  We 
are  not  aware  of  this  constant  excretion  of  fluids,  which 
is  termed  "insensible  perspiration,"  but  it  continues  even 
in  cold  weather  and  must  not  be  stopped  if  health  is  to  be 
preserved.  If  the  oil,  dust,  particles  of  dead  skin  and  the 
waste  material  left  by  dried  perspiration  are  allowed  to 
remain  upon  the  surface  of  the  body  they  will  clog  the 
pores,  or  gland  openings,  and  thus  interfere  with  their  ac- 
tion. The  removal  of  this  material,  then,  is  necessary  to 
maintain  health,  and  is  done  automatically  in  part  for 
the  fluid  evaporates  and  much  of  the  solid  matter  is  rubbed 
off  on  the  clothing.  The  most  important  aids  to  the 
skin's  activity  are  the  drinking  of  plenty  of  water,  deep 
breathing,  exercise  and  warm  baths. 

Regular  and  thorough  bathing  serves  the  double  purpose 
of  removing  waste  matter  already  on  the  surface,  and  of 
stimulating  the  glands  to  increased  activity  in  giving  oft' 
still  more. 

Many  doctors  advise  a  warm,  not  hot,  shower  or  tub  bath 


CARE  OF  THE  IJAP.V  BEFORE  HE  COMES     55 

every  day,  with  soap  used  freely  over  tlie  entire  body,  fol- 
lowed by  a  brisk  rub.  The  best  time  for  this  warm,  cleans- 
ing batii,  as  a  rule,  is  just  before  rctii-ina:,  as  it  is  soothing 
and  restful,  and  tends  to  induce  sleep.  Very  hot  baths  are 
fatiguing,  particularly  during  jiregnancy.  and  should  never 
be  taken  except  with  the  doctor's  i)erniission ;  but  cold 
baths  usually  may  be  contiinied  througliout  pregnancy  if 
one  is  accustomed  to  them  and  reacts  well  afterwards.  Un- 
der these  conditions  the  morning  cold  plunge,  shower  or 
sponge  is  beneficial,  as  it  stimulates  the  circulation  and 
thus  promotes  the  activity  of  the  skin.  Some  doctors  for- 
bid tub  bathing  of  any  kind  after  the  seventh  month,  on  the 
ground  that  as  the  expectant  mother  sits  in  the  tub  her  va- 
gina is  filled  Avith  unsterile  water  and  should  labor  occur 
shortly  afterward  an  infection,  or  fever,  might  result.  And 
as  she  is  heavy  and  somewhat  uncertain  on  her  feet,  there 
is  also  the  danger  of  her  slipping  and  falling  while  getting 
in  or  out  of  the  tub.  Other  doctors  permit  tub  baths 
throughout  pregnancy,  up  until  the  onset  of  labor ;  while 
as  to  hot  foot  baths,  since  there  seems  to  be  no  reason  for 
or  against  them  at  any  time  during  the  nine  months,  they 
may  be  taken  or  not  at  will. 

Bathing  in  a  quiet  stream  or  lake  is  apparently  harmless 
but  sea  bathing,  if  the  surf  is  rough,  is  inadvisable  because 
of  the  beating  of  the  waves  upon  the  abdomen  and  the  gen- 
eral violence  of  the  exercise. 

The  importance  of  keeping  the  body  evenly  warm 
throughout  pregnancy  cannot  be  overemphasized,  for  a  sud- 
den chilling  or  wetting  may  so  check  action  of  the  skin  as 
to  impose  more  of  a  burden  upon  the  kidneys  than  they 
can  meet,  in  their  effort  to  throw  off  the  skin 's  share  of  the 
body  waste.  Accordingly,  a  single  chilling  will  sometimes 
be  enough  to  cause  convulsions.  This  may  be  one  reason 
why  convulsions  occur  more  frequently  during  cold  weather 


56         GETTING  READY  TO  BE  A  MOTHER 

or  after  a  sudden  drop  in  the  temperature  after  warm  or 
mild  days. 

The  Bowels.  The  bowels,  also,  throw  off  a  certain 
amount  of  impurities  and  if  they  do  not  move  thoroughly 
at  least  once  a  day  these  impurities  may  be  taken  into  the 
system  and  again  the  kidneys  be  given  extra  work. 

Unhappily  a  great  many  pregnant  women  are  consti- 
pated, particularly  during  the  later  weeks,  while  women 
who  have  always  had  a  tendency  of  this  kind  may  have 
trouble  with  their  bowels  from  the  very  beginning  of  preg- 
nancy. Your  bowels  should  move  regularly  every  day, 
and  to  this  end  you  should  attempt  to  empty  them  at  the 
same  hour  each  day,  immediately  after  breakfast  being  the 
best  time.  The  importance  of  regularity  in  making  the 
attempt  cannot  be  overemphasized,  even  though  the  bowels 
do  not  always  move. 

The  measures  which  tend  to  prevent  constipation,  as  al- 
ready pointed  out,  are  drinking  plenty  of  fluids,  and  eating 
fresh  fruit,  coarse  vegetables  and  bulky  cereals  such  as 
bran ;  also  taking  a  glass  of  hot  or  cold  water  just  before 
going  to  bed  and  the  first  thing  in  the  morning.  You  should 
not  take  enemas  or  cathartics  without  j'our  doctor's  order, 
but  you  may  safely  increase  the  amount  of  fluids  which 
you  drink  and  the  bulk  of  your  food,  in  order  to  regulate 
your  bowels. 

Senna  and  prunes  cooked  together  prove  to  be  helpful 
in  keeping  the  bowels  regular  and  the}"  are  entirely  harm- 
less. A  simple  way  of  preparing  them  for  this  purpose 
is  to  pour  a  quart  of  boiling  water  over  an  ounce  of  senna 
leaves  and  allow  them  to  stand  for  about  two  hours.  A 
pound  of  well  washed  prunes  should  soak  overnight  in  this 
liquor,  after  it  has  been  strained,  and  then  cooked  in  it  until 
tender.  They  may  be  sweetened  with  two  tablespoonfuls 
of  brown  sugar,  and  the  flavor  improved  by  adding  a  stick 


CARK  OF  TIJK  HAI'.V  1;KK(>KI<:   1 1 10  COMKS      57 

of  cinnamon  or  slice  of  lemon  while  they  are  cooking?.  Half 
a  dozen  of  these  prunes,  witii  some  of  tlie  syrup,  may  be 
taken  at  the  evening  meal  to  start  with,  and  increased  or 
decreased  in  number  as  necessary. 

Clothes.  The  chief  i)urp()se  of  clothes  under  all  condi- 
tions is  to  aid  in  keepinji'  the  body  warm,  thus  helping  to 
preserve  an  even  circulation  of  the  blood  and  the  activity  of 
the  sweat  glands.  As  has  been  jwinted  out,  this  is  of  espe- 
cial importance  during  pregnancy.  Tlu'  expectant  mother's 
clothes  should  be  not  only  sutificiently  wai-m,  but  they  should 
be  equally  warm  over  her  entire  body.  They  should  be  light 
and  porous,  and  fairly  loose,  so  as  iiot  to  interfere  with  the 
circulation  or  other  bodily  functions.  There  must  be  no 
pressure  on  chest  or  abdomen  ;  no  tight  garters,  belts,  collars 
or  shoes. 

The  clothes  of  the  mother-to-be,  like  every  other  detail 
of  her  care,  must  be  adapted  to  her  surrouiulings  and  mode 
of  living.  If  her  house  is  well  and  evenly  heated  during 
tiie  cold  months,  she  may  <iuite  safely  dress  lightly  while  in- 
doors ;  if  it  is  not,  she  should  wear  underwear  with  high 
neck,  long  sleeves  and  drawers,  both  indoors  and  out,  excei)t 
when  the  weather  is  warm  enough  to  cause  perspiration. 
At  all  times,  however,  the  warmth  of  her  clothing  should 
be  suited  to  the  temperature  of  the  home,  the  climate  and 
the  state  of  the  weather. 

Remembering  that  it  is  important  for  you  to  keep  up 
the  diversions  and  amusements  that  you  enjoy,  it  is  worth 
while  to  have  your  clothes  as  pretty  and  becoming  as  pos- 
sible, for  you  are  much  more  likely  to  go  about  and  mingle 
with  your  friends  if  you  feel  that  you  are  becomingly  and 
well  dressed.  At  the  same  time  your  clothes  should  be  so 
made  that  their  weight  will  hang  from  the  shoulders  instead 
of  from  the  waistband. 

And  that  brings  us  to  the  question  of  corsets,  a  much 


58         GETTING  KEADV  TO  BE   A  MOTHER 

discussed  garment.  Women  who  have  not  been  accustomed 
to  wearing  corsets  will  scarcely  feel  the  need  of  adopting 
them  during  pregnancy  except,  perhaps,  during  the  later 
weeks  when  the  heavy  abdomen  needs  to  be  supported  for 
the  sake  of  comfort.  This  need  is  felt  particularly  by 
Avomen  who  have  had  children  and  whose  abdominal  walls 
are  somewhat  weakened  in  consequence. 

If  you  have  been  wearing  comfortable,  well  fitting  cor- 
sets, you  probably  will  not  feel  the  need  of  making  a  change 
until  the  third  or  fourth  month.  But  by  this  time  the  baby 
will  have  pushed  up  out  of  the  lower  ijelvis  into  the  abdo- 
men and  your  corsets  then,  if  you  wear  any,  must  be  so 
constructed  that  they  will  not  compress  nor  disguise  your 
figure,  but  will  provide  support  and  accommodate  them- 
selves to  an  abdomen  that  is  steadily  increasing  in  size  and 
changing  in  shape.  Such  corsets  are  made  of  soft  material ; 
have  elastic  inserts  and  have  lacings  at  the  sides  as  well  as 
in  the  back.  They  come  well  down  and  tit  snugly  over  the 
hips.  (See  Fig.  10.)  Some  women  find  comfort  in  attach- 
ing shoulder  straps  to  their  corsets  thus  suspending  some  of 
the  abdominal  weight  from  the  shoulders.  But  as  a  rule, 
the  most  comfortable  arrangement  is  a  short-waisted  mater- 
nity corset  worn  with  a  brassiere  that  supports  the  breasts 
and  does  not  compress  the  nipples. 

I  hope  this  description  will  make  clear  to  you  why  the 
same  style  corsets  as  you  ordinarily  wear  cannot  be  satis- 
factory during  pregnancy,  no  matter  how  large  they  are, 
and  may  even  prove  harmful. 

Even  a  i^roperly  fitting  maternity  corset  may  become 
uncomfortable  during  the  last  few  weeks  of  pregnancy, 
and  have  to  be  replaced  by  an  abdominal  supporter  of 
linen  or  rubber.  And  when  this  stage  is  reached,  even 
the  woman  who  has  worn  no  corsets  may  find  that  she  is 
more    comfortable    if    she    adopts    such    a    support,    par- 


i 


/ 


^1 


^? 


Fig.  10. — Front  and  side  views  of  a  satisfactory  maternity  corset, 
adjusted  at  the  fifth  month  of  pregnancy.  (By  courtesy  of  Emma  E. 
Goodwin,  New  York.) 

59 


60 


GETTING  READY  TO  BE  A  MOTHER 


ticularly  at  night.  There  are  many  admirable  hinders  on 
the  market,  or  such  an  one  as  is  illustrated  in  Figs.  11 
and  12  may  easily  be  made  at  home  as  well  as  comfortabls 


Fig.  11. — Front,  side  and  back  viewp  of  home-made  binder  for 
supporting  a  heavy,  pendulous  abdomen  during  later  weeks  of  preg- 
nancy. It  is  adjusted  as  the  expectant  mother  lies  down,  the  ends 
being  crossed  in  the  back  and  pinned  to  the  lower  marfyin  of  the 
front,  th'js  g-iving  additional  support. 

Also  breast -binder  made  of  a  straight  strip  of  soft  cotton  material, 
10  or  12  inches  wide  and  2  yards  long.  This  is  crossed  in  front  and 
held  with  safety-pins,  the  ends  being  carried  over  the  shoulders  and 
pinned  to  the  back  of  the  binder.  It  should  be  snug  below  the  breasts 
but  loose  over  the  nipples.  The  openings  over  the  nipples  show  how 
this  binder  may  be  used  to  support  the  breasts  of  the  nursing  mother. 
(From  photographs  taken  at  the  Maternity  Centre  Association,  New 
York.) 


CARE  OF  THE  BABY  BEFORE  HE  COMES  01 

and  inexpensive  stoekinp:  supporters,  made  from  tapes  or 
strips  of  nmsliii,  as  in  Fig.  13. 

Your  shoes,  also,  merit  some  thought,  for  your  feet  will 
probably  be  larger  during  the  latter  part  of  pregnancy, 
partly  because  of  the  possibility  of  their  being  somewhat 
swollen  and  partly  because  the  increased  weight  of  your 
body  tends  to  spread  them.  This  added  weight  also  in- 
crea^^es  the  strain  put  upon  the  arch  and  as  a  result,  flat-foot 
is  fairly  common  among  expectant  mothers  who  have  not 
taken  pains  to  have  their  arches  well  supported.   Your  shoes 


Fig.  12. — Abdominal  binder  used  in  Fiti.  11,  showing  darts  at  top  of 
front  to  lit  it  over  the  abdomen. 

would  better  be  an  inch  longer  than  those  ^-ou  ordinarily 
wear;  the}'  should  have  broad,  common-sense  heels  and  fit 
snugly  over  the  instep,  in  spite  of  being  full  large.  If  your 
shoes  are  not  comfortable  you  will  find  yourself  tiring  easily 
and  for  this  reason  will  tend  to  take  less  exercise  than  you 
should. 

Another  reason  for  the  need  of  proper  shoes  is  that  as 
pregnancy  advances  the  expectant  mother  becomes  rather 
unsteady  on  her  feet,  and  broad,  firm  heels  help  to  make 
her  feel  more  secure.  The  heels  need  not  be  flat  at  first, 
if  3'ou  have  been  accustomed  to  wearing  high  ones,  for  the 
sudden  lowering  of  the  heels  may  injure  your  arches,  but 
as  the  weeks  wear  on  you  would  better  adopt  moderately 
low  heels.  High  French  heels  should  be  avoided  because 
they  not  onlv  increase  the  ditficultv  and   discomfort   of 


62 


GETTING  READY  TO  BE  A  MOTHER 


walking  but  cause  backache,  as  well,  by  forcing  a  position 
that  adds  to  the  pressure  on  the  lower  part  of  the  abdomen. 
They  increase  the  risk  of  turning  the  ankles,  too,  and  of 


Fig.  13. — Front  and  back  view  of  home-made  stocking  supporters 
made  of  webbing  or  1-inch  strips  of  muslin  and  a  pair  of  child's  side 
garters.  The  straps  are  sewed  together  in  the  back,  but  pinned  in 
front  to  permit  adjustment  as  the  abdomen  enlarges.  (By  courtesy 
of  the  Maternity  Centre  Association,  New  York.) 


tripping  and  falling,  which  is  a  very  serious  accident  for 
the  expectant  mother. 

Fresh  Air.  If  you  realize  by  this  time  how  important  it 
is  to  keep  your  digestion  in  good  order  and  promote  the 
activity  of  all  your  excretory  organs,  you  probably  suspect 
how  important  fresh  air  and  exercise  are  to  you  and  your 


CAllH  OK  'rilK    I'.AIiV    nKKoliK    UK  COMKS     (i:5 

expected  baby,  because  of  their  effect  upon  your  entire  well- 
being. 

The  average  individual  uses  up  in  a  ininult-'s  time  the 
oxygen  contained  in  four  bushels  of  air,  and  since  the  preg- 
nant woman  takes  in  through  her  lungs  the  oxygen  for 
both  herself  and  her  baby,  she  must  have  a  sufficient  quan- 
tity of  air  to  supply  at  least  this  amount. 

Accordingly,  you  should  make  a  point  of  spending  at 
least  two  hours  of  each  day  in  the  open  air.  If  the  weather 
is  so  stormy  or  severe  as  to  make  it  undesirable  for  you  to 
go  out  from  under  cover,  because  of  the  danger  of  getting 
wet  or  chilled,  you  can  wrap  up  well  and  take  your  airing 
on  a  protected  porch  or  in  a  room  with  all  the  windows 
wide  open. 

But  this  is  only  a  part  of  it,  for  the  air  in  your  house  or 
rooms  must  be  kept  fresh  all  day  by  being  constantly 
changed ;  this  requires  a  steady  inpourhig  of  fresh  air  and 
outpouring  of  stale  air. 

A  very  good  way  to  accomplish  this  is  to  have  one  or  more 
windows  open  slightly,  top  and  bottom,  all  the  time.  But 
there  must  be  no  sudden  changes  of  temperature,  nor  drafts, 
for  fear  of  chilling  your  skin.  At  night  you  should  sleep 
in  a  room  with  the  windows  open,  taking  care  to  be  well 
protected  by  light,  warm  coverings. 

Exercise.  Each  detail  of  the  expectant  mother's  daily 
routine  seems  to  be  more  important  than  the  last.  And  so 
when  we  come  to  the  question  of  regular  out-of-door  exercise 
we  are  almost  persuaded  to  believe  that  whatever  else  may 
be  neglected,  this  is  indispensable,  since  it  promotes  diges- 
tion, stimulates  the  activity  of  the  skin  and  lungs,  steadies 
the  nerves,  quiets  the  mind  and  promotes  sleep.  And  more 
than  that,  walking,  which  is  probably  the  most  satisfactory 
form  of  exercise  for  her  to  take,  also  strengthens  some  of 
the  muscles  that  are  used  during  labor.     But  exercise  is 


64         C4ETTING  READY  TO  BE  A  MOTHER 

downright  injurious  if  continued  to  the  point  of  fatigue, 
no  matter  how  little  has  been  taken.  Each  woman  must 
be  a  law  unto  herself  in  this  matter,  therefore,  and  must  be 
impressed  with  the  importance  of  stopping  before  she  is 
tired.  It  may  be  a  good  plan  for  you  to  start  by  walking 
only  a  short  distance  at  a  time,  increasing  this  gradually 
until  you  are  able  to  walk  possibly  as  much  as  an  hour  in 
the  morning  and  an  hour  in  the  afternoon  without  fatigue. 

All  violent  exercise  and  sports  are  of  course  to  be  avoided, 
particularly  swimming,  horseback  riding  and  tennis.  AVhile 
motoring  and  carriage  driving  are  pleasant  diversions,  they 
cannot  be  classed  as  exercise.  They  should  be  taken  only  in 
comfortable  vehicles  and  over  smooth  roads,  so  that  there 
will  be  no  jarring  nor  jolting,  and  the  expectant  mother 
should  not  do  tlie  driving  herself. 

A  certain  amount  of  exercise,  in  the  shape  of  light  house- 
work, may  be  taken  indoors.  This  is  distinctly  beneficial 
if  not  continued  to  the  point  of  fatigue,  both  because  of  the 
exercise  which  it  provides,  and  also  the  diversion  and 
interest,  for  these  promote  mental  and  physical  health.  But 
this  indoor  exercise  must  not  interfere  with,  nor  to  any 
degree  replace  the  daily  exercise  which  you  take  out  of 
doors ;  nor  must  it  include  heavy  work,  such  as  washing, 
sweeping,  heavy  lifting,  running  a  sewing  machine  by  foot 
or  much  running  up  and  down  stairs. 

However,  the  amount  and  kind  of  work  which  the  ex- 
pectant mother  may  comfortably  and  safely  do,  are  so 
related  to  what  she  has  been  accustomed  to,  that  it  is  not 
possible  to  do  more  than  describe  what  has  proved  of  benefit 
for  the  average  woman. 

There  are  women  to  whom  massage  and  gymnastics  are 
helpful  during  pregnancy  when  for  some  reason  the  out-of- 
door  activities  are  not  possible  or  advisable.  This  might 
be  true  of  an  expectant  mother  with  heart  trouble,  for  ex- 


CARE  OF  THE  I'.AliV  151-:F()1{I«:  HE.  COMES     65 

ample,  or  of  one  who  is  being  kept  in  bed  to  prevent  an 
abortion  and  according:ly  is  a  matter  Avhich  is  closely  di- 
rected by  the  doctor. 

Traveling.  In  «z('iieral,  traveling  is  less  dangerous  for 
the  expectant  mother  of  to-day  than  formerly  because  it 
causes  less  strain,  discomfort  and  fatigue  than  in  the  old 
days.  But  the  question  cannot  be  settled  once  for  all  women 
nor  for  all  stages  of  pregnancy.  Each  woman's  general 
condition  must  be  considered ;  her  tendency  to  nausea ;  tlie 
length  of  the  journey  and  the  ease  with  which  it  may  be 
made ;  also,  whether  or  not  she  has  ever  had  or  been  threat- 
ened with  an  abortion.  As  a  rule,  it  is  considered  wise  to 
avoid  traveling  during  the  first  sixteen  and  the  last  four 
weeks  of  pregnancy,  and  at  the  time  of  the  month  when 
menstruation  would  ordinarily  occur.  Certainly  a  journey 
should  not  be  undertaken  at  any  time  during  pregnancy 
without  a  doctor's  permission. 

Rest  and  Sleep.  When  we  studied  the  changes  that  take 
place  during  pregnane}^  we  found  that  as  the  abdomen  in- 
creased in  size  and  weight  the  expectant  mother  was  re- 
quired to  make  a  constant,  though  unconscious  effort  to 
stand  upright.  This  is  probably  one  reason  for  the  fatigue 
which  she  so  often  feels  without  apparent  cause,  and  why, 
upon  exertion,  she  tires  more  easily  than  usual. 

Accordingly,  you  may  find  it  necessary  to  rest  frequently 
during  the  day  in  order  to  avoid  the  ill  effects  of  fatigue. 
It  is  a  good  plan  to  work  and  exercise  in  short  periods  rather 
than  long,  always  lying  down  when  tired,  and  for  an  hour 
or  two  after  the  noon  meal.  You  should  be  careful  not 
to  be  over  active  or  to  overexert  yourself  at  the  time  when 
menstruation  would  occur  if  you  were  not  pregnant,  for 
fear  of  bringing  on  an  abortion.  This  precaution  is  partic- 
ularly important  during  the  first  four  months,  the  period 
when  abortions  occur  most  frequently. 


66    GETTING  READY  TO  BE  A  MOTHER 

Since  eight  hours'  sleep  is  usually  considered  necessary 
to  keep  the  average  person  in  good  condition,  you  can 
scarcely  expect  to  get  along  satisfactorily  with  less.  In  fact, 
this  is  so  important  to  your  general  well-being  that  you 
should  make  a  serious  effort  to  secure  it. 

Fresh  air  during  the  day  and  open  windows  at  night; 
prudent  eating ;  a  comfortable  bed  furnished  with  warm 
but  light  bedding ;  warm  baths ;  a  hot  water  bag  to  the  feet 
and  a  hot  drink  upon  retiring  are  all  conducive  to  sleep. 

But  in  addition  to  these,  and  perhaps  of  even  more  im- 
portance, are  cheerfulness  and  a  tranquil,  untroubled  state 
of  mind. 

Breasts.  Breast  feeding  is  the  most  urgent  single  need 
of  the  baby,  for  whose  coming  we  are  making  preparations, 
and  practically  every  mother,  excepting  those  with  definite 
physical  disability,  can  supply  this  need  of  her  baby 's  if  she 
gives  herself  proper  care  both  before  and  after  his  birth. 
You  will  be  glad  to  know  in  this  connection  that  everj^thing 
that  promotes  your  general  health  helps  to  prepare  you  to 
nurse  your  baby,  but  there  is  need  also  for  care  of  the 
breasts  and  nipples  themselves,  to  make  the  nursing  satis- 
factory, and  to  prevent  sore  nipples  and  possibly  even 
breast  abscesses. 

Briefly,  this  local  care  consists  of  supporting  heavy 
breasts,  but  avoiding  pressure;  bringing  out  flat  or  re- 
tracted nipples  and  toughening  the  skin  which  covers  them. 

After  they  become  heavy  and  uncomfortable  the  breasts 
may  be  supported  by  brassieres,  which  are  snug  below  the 
breasts,  loose  over  the  breasts  themselves  and  suspended 
from  shoulder  straps ;  or  by  some  such  binder  as  is  shown 
in  Fig.  11,  which  answers  the  same  purpose. 

If  your  nipples  are  flat  or  retracted,  you  should  begin 
about  the  fifth  month  to  make  them  more  prominent  in 
order  that  when  the  baby  nurses  he  may  be  able  to  grasp 


CARE  OF  THE  BABY  BEFORE  HE  COMES  67 

them  easily.  There  are  several  ways  of  accomplishing 
this,  all  of  them  in  the  nature  of  massage,  but  whatever 
is  done  must  he  done  regularly  and  persistently.  One  sira- 
l)le  and  effective  method  is  to  grasp  the  nipple  between  the 
thumb  and  forelinger,  draw  it  out,  hold  it  for  a  moment, 
then  release  it  and  allow  it  to  retract.  This  should  be  done 
over  and  over,  two  or  tliree  times  daily.  Or  the  unstoppered 
opening  of  a  warm  l)ottle  may  be  placed  over  a  flat  nipple 
and  held  in  place  until  the  nipple  is  drawn  up  into  the  neck 
of  the  bottle  as  it  cools  and  a  partial  vacuum  is  formed. 

The  toughening  of  the  nipples  should  be  begun  eight 
weeks  before  the  baby  is  expected.  There  are  two  general 
methods  which  seem  to  give  about  equally  satisfactory  re- 
sults. One  is  to  soften  the  skin,  and  the  other  is  to  harden 
it.  In  either  case  the  nipples  should  first  be  scrubbed  gently 
with  a  soft  brush  or  cloth,  warm  water  and  soap,  for  about 
five  minutes  night  and  morning.  After  the  scrubbing  they 
should  be  rubbed  with  lanolin,  cocoa  butter  or  vaselin  and 
covered  with  a  piece  of  clean  soft  cloth  or  gauze,  to  protect 
the  clothing.  Or,  they  may  be  bathed  with  a  wash  consisting 
of  equal  parts  of  a  saturated  solution  of  boracic  acid  and 
95  per  cent  alcohol.  You  will  probably  have  to  have  a  drug- 
gist prepare  this  for  you  because  of  the  alcohol. 

But  no  matter  which  course  is  followed  the  care  must  be 
regular  to  be  effective.  You  will  find  that  matters  will  be 
simplified  if  you  will  assemble  in  one  place  and  keep  in 
readiness  the  soap,  brush  and  lotion  or  ointment  which  you 
use  each  time,  using  them  for  no  other  purpose. 

Care  of  the  Teeth.  It  is  very  important  for  the  expect- 
ant mother  to  give  her  teeth  scrupulous  care  from  the  be- 
ginning of  pregnancy,  for  in  addition  to  the  ordinary  wear 
and  tear  with  which  Ave  all  have  to  cope,  her  tendency  to 
have  an  acid  stomach  makes  her  mouth  acid  and  this  is 
bad  for  her  teeth.    Accordingly,  in  addition  to  using  dental 


68    GETTING  READY  TO  BE  A  MOTHER 

floss  and  brushing  your  teeth  after  each  meal,  you  should 
use  an  alkaline  mouth  -wash  several  times  daily,  particularly 
after  vomiting  and  before  retiring,  for  much  damage  may 
be  done  by  the  acid  secretions  in  the  mouth  if  they  are  al- 
lowed to  bathe  the  teeth  during  the  long  night  stretches. 
Common  baking-soda  (a  teaspoonful  to  a  tumbler  of  water), 
lime  water  or  milk  of  magnesia  all  make  excellent  mouth 
washes.  It  is  important,  also,  that  you  consult  a  dentist 
as  soon  as  you  know  tluit  you  are  pregnant  and  have  any 
necessary  repairs  done  pi-omptly,  fo?-  delay  may  be  serious. 

COMMON   DISCOMFORTS   DURING  PREGNANCY 

You  may  have  a  number  of  minor  ills  and  temporary 
disturbances  during  pregnancy  which  are  not  serious  but 
capable  of  making  you  ver,y  uncomfortable,  and  which  you 
may  sometimes  relieve  yourself.  But  should  they  be  severe 
or  persistent,  you  should  consult  your  doctor  at  once.  The 
most  common  of  these  minor  discomforts  may  be  grouped 
as  digestive  disturbances  and  "  ])ressure  symptoms." 

Chief  among  the  digestive  disturbances  are  "morning 
sickness,"  ''heartburn."  ''distress"  and  flatulence  or 
"gas." 

"Morning  sickness"  is  i)rol)ably  the  commonest  discom- 
fort of  pregnancy  as  it  occurs  in  about  half  of  all  eases. 
Because  of  the  expectant  mother 's  tendency  to  nausea  dur- 
ing the  early  months,  it  may  be  brought  on  by  slight  causes 
which  would  not  i)roduce  nausea  under  ordinary  condi- 
tions. While  it  is  true  that  grief,  anxiety,  fright,  shock, 
incessant  worry,  fits  of  temper  or  brooding  maj''  induce 
nausea  when  the  diet  is  entirely  satisfactory,  nausea  and 
even  vomiting  may  be  caused  in  the  expectant  mother  just 
as  they  may  in  any  one  else  Ity  indisci'etions  in  diet,  rapid 
or  over-eating.    On  ihc  otlicr  Inmd.  simple,  light  food  taken 


CAKb:  OK  'nil-:  ]\\\\\  I'.iii'oiM-:  iii-;  comios    (i!» 

in  small  qnaiilitics,  live  or  six  times  daily,  eaten  slowly  and 
masticated  thorouj'hiy ;  the  eulti^■ati()ll  oi'  a  liajjpy  frame 
of  mind;  exercise  and  fresh  air  ail  tend  to  prevent  this 
very  uncomfortable  condition. 

Prevention  is  of  <»reat  importance,  as  the  hal)it  of  vomit- 
ing is  acquired  easily  hut    broken   up  with  difficulty. 

AYlien  "morning'  sickness"  occurs,  however,  the  sufferer 
is  often  relieved  by  eating  two  or  three  hard,  uaisweetened 
crackers  or  crisp  toast,  immediately  upon  awaking  and  then 
lying  still  for  half  or  thi'ce  quarters  of  an  hour.  She  should 
then  dress  slowly,  sitting  down  as  much  as  possible  while 
doing  so,  and  eat  her  regular  breakfast.  Lying  tlat,  without 
a  pillow  for  a  little  while  after  meals,  or  Avhenever  having 
the  slightest  feeling  of  sickness,  will  frequently  prevent,  and 
also  relieve  nausea.  Sometimes  comfort  is  derived  from 
the  use  of  either  hot  or  cold  apjilications  over  the  stomach. 
Some  expectant  mothers  find  that  they  can  prevent  nausea 
by  having  hot  coffee,  or  exen  a  full  breakfast  before  arising. 
But  the  habit  of  having  breakfast  in  bed  should  not  be  cul- 
tivated lightly,  foi-  in  spite  of  yourself  it  is  likely  to  make 
you  feel  like  an  invalid,  the  tiling  you  should  carefully 
avoid.    So  don't  do  it  unless  your  doctor  orders  it. 

"Heartburn,"  so  called,  which  is  suffered  by  so  many 
expectant  mothers,  has  nothing  to  do  with  the  heart.  It  is 
due  entirely  to  too  much  acid  in  the  stomach  and  is  usually 
felt  as  a  burning  sensation,  which  starts  in  the  stomach  and 
rises  into  the  throat.  It  may  be  prevented,  as  a  rule,  by 
taking  a  tablespoonful  of  olive  oil  or  a  cupful  of  cream  or 
rich  milk  fifteen  or  twenty  minutes  before  meals  and  avoid- 
ing fat  and  fried  food  at  the  meals  themselves.  Or,  it  may 
be  enough  simply  to  avoid  eating  fats  and  fatty  foods. 
Since  the  painful,  burning  sensation  is  directly  due  to  too 
much  acid  in  the  stomach,  it  usually  may  be  relieved  by 
taking  a  tablespoonful  of  lime  water;  a  teaspoonfid  of  so- 


70         GETTING  READY  TO  BE  A  MOTHER 

dium  bicarbonate  in  water;  a  small  piece  of  magnesium 
carbonate  ;  or  a  drink  of  any  alkaline  water  that  one  fancies. 

"Distress."  Another  common  discomfort  of  pregnancy 
is  called  "distress"  by  the  sufferers  themselves,  and  occurs 
after  eating.  It  may  be  neither  heartburn  nor  pain,  but  re- 
semble both  and  make  the  expectant  mother  very  miser- 
able. It  is  usually  suffered  by  women  who  eat  rapidly,  do 
not  chew  their  food  thoroughly  or  Avho  eat  more  at  one ' 
time  than  the  stomach  can  hold  comfortably.  This  is  one 
more  reason  for  taking  small  amounts  of  food  at  a  time, 
eating  slowly  and  masticating  thoroughly. 

Flatulence,  or  * '  gas, ' '  may  or  may  not  be  associated  with 
heartburn,  but  is  fairly  common  among  expectant  mothers, 
and  is  rather  uncomfortable.  A  daily  bowel  movement  is 
of  prime  importance  in  preventing  and  relieving  flatulence 
and  at  the  same  time  foods  which  form  gases  should  be 
carefully  omitted  from  the  diet.  The  chief  offenders  are 
parsnips,  beans,  corn,  fried  foods,  sweets  of  all  kinds,  pastry 
and  very  sweet  desserts.  Yeast  cakes  and  artificially  fer- 
mented milk  sometimes  help  to  prevent  flatulence. 

Pressure  Symptoms.  Under  the  general  heading  of 
pressure  symptoms  are  several  forms  of  discomfort  result- 
ing from  pressure  of  the  enlarged  uterus  (containing  the 
baby)  on  the  blood-vessels  which  return  from  the  lower 
part  of  the  body,  thus  interfering  with  the  flow  of  blood 
back  to  the  heart.  The  commonest  pressure  symptoms  are 
swollen  feet,  varicose  veins,  hemorrhoids  (piles),  cramps  in 
the  legs  and  shortness  of  breath.  They  may  appear  at  any 
time  during  the  last  half  of  pregnancy  and  they  grow  worse 
as  the  weeks  wear  on. 

Swelling  of  the  feet  is  very  common,  and  when  very 
slight  may  not  be  serious  or  particularly  uncomfortable. 
The  swelling  may  be  confined  to  the  back  of  the  ankle,  which 
grows  white  and  shining,  or  it  may  extend  all  the  way  up 


CARE  OF  THE  BABY  BEFORE  HE  COMP:S  71 

the  legs  to  the  thighs.  Sitting  down,  willi  the  feet  resting 
on  a  chair,  or  lying  down  with  the  feet  elevated  on  a  pillow 
will  give  a  certain  anion nt  of  relief.  If  the  swelling  and 
discomfort  arc  extreme,  the  expectant  mother  may  have  to 
go  to  bed  until  they  subside,  but  very  often  slie  will  be  re- 
lieved bv  elevating  her  feet  or  assuming  the  right-angled 


Fig.  14. — Right  angled  position  to  relieve  swelling  or  varicose 
veins  of  the  feet  and  legs.  (By  courtesy  of  the  Maternity  Centre 
Association.) 

position  shown  in  Fig.  14,  for  even  a  little  while,  several 
times  a  day.  But  while  employing  these  harmless  measures 
to  make  yourself  comfortable,  you  must  remember  that  the 
swelling  of  your  feet  and  ankles  is  one  of  the  symptoms  that 
your  doctor  wants  to  know  about.  For  this  reason  you. 
should  promptly  report  to  him  even  the  slightest  swelling 
and  begin  to  measure  and  save  your  urine  for  examination. 


72         GETTING  READY  TO  BE  A  MOTHER 

Varicose  veins  are  not  peculiar  to  pregnancy  but  they 
are  among  the  pressure  symptoms  which  frequently  appear 
during  the  later  months,  i^articularly  among  women  who 
have  borne  children.  The  enlargement  of  the  veins  is  not 
usually  serious  but  it  may  cause  a  good  deal  of  discomfort. 
While  varicose  veins  may  occur  in  the  vulva,  they  are  usu- 
ally confined  to  the  legs,  and  both  legs  are  about  equally 
affected.  Sometimes,  however,  the  veins  in  the  right  leg  are 
more  distended  than  those  in  the  left,  or  the  right  side  alone 
may  be  affected. 

Considerable  relief  may  be  obtained  by  keeping  off  the 
feet,  particularly  by  elevating  them,  and  also  by  the  use 
of  elastic  bandages.  When  an  expectant  mother  finds  it 
difficult  or  nearly  impossible  to  sit  or  lie  down  for  any 
length  of  time,  she  may  secure  great  relief  in  a  few  moments 
by  lying  flat  on  the  bed  Avitli  her  legs  extended  straight  into 
the  air,  at  right  angles  to  her  body,  resting  against  the  wall 
ox  head  board,  as  shown  in  Fig.  14.  This  right-angled  posi- 
tion for  five  minutes,  three  or  four  times  a  day,  will  accom- 
plish wonders  in  reducing  varicose  veins. 

A  spiral  elastic  bandage,  also,  will  give  comfort  and  help 
to  prevent  the  veins  from  growing  larger,  if  applied  freshly 
after  each  time  that  the  \eg  is  elevated.  The  most  satisfac- 
tory bandages,  from  the  standpoint  of  expense,  comfort  and 
cleanliness,  are  of  stockinette  or  of  flannel  cut  on  the  bias, 
measuring  three  or  four  inches  wade  and  eight  or  nine  yards 
long.  If  made  of  flannel,  the  selvages  should  be  whipped 
together  smoothly  so  that  there  is  neither  ridge  nor  pucker 
at  the  seam.  The  bandage  should  be  wrapped  around  the 
leg  with  firm,  even  pressure,  starting  with  a  few  turns 
over  the  foot  to  secure  it,  and  leaving  the  heel  uncovered, 
carried  up  the  leg  to  a  point  above  the  highest  swollen 
vessels.    As  a  rule  the  bandage  may  be  left  off  at  night. 

There  are  satisfactory  elastic  stockings  on  the  market,  but 


CARE  OK  TlIK   I'.AI'.V   UKKoKl-:   UK  COMES     73 

they  arc  laitly  ex  pensive,  often  caiuiot  he  washed  and 
seem  to  offer  no  [iractical  advantfige  over  the  bandages. 

Swollen  veins  in  the  vulva  may  be  relieved  by  lying  flat 
and  elevating  the  hips,  or  by  lying  on  the  side  with  the  hir^ 
elevated  on  a  pillow  t'oi-  a  few  moments  several  times  a  day, 
as  shown  in  V\g.  15. 

Hemorrhoids,  or  "i^iles, "  are  virtually  varicose  veins 
which  jiroti-nde  fi-oin  the  reetum,  but,  unlike  tliose  in  the 


-—■■^—- 

k 

M 

i 

*               ^4^1^ 

"ifl 

k 

■ 

Fig.  15. — Lyinj^-  on  the  side  with  hips  elevated  to  relieve  swelling 
or  varicose  veins  of  the  vulva.  (By  courtesy  of  the  Maternity  Centre 
Association.) 


legs,  are  extremely  |)aint'ul.  As  it  is  the  straining  in  con- 
stipation that  causes  these  enlarged  veins  to  protrude  from 
the  rectum,  this  is  one  more  reason  for  preventing  con- 
stipation, for  a  pregnant  woman  whose  bowels  move  freely 
every  day  rarely  has  hemorrhoids.  If  hemorrhoids  appear, 
and  give  pain,  the  first  step  is  to  soften  the  fingers  with 
vaseliii  and  gently  push  the  hemorrhoids  back  into  the 
rectum.  You  can  do  this  quite  easily  for  yourself.  "Lou 
should  notify  your  doctor  if  you  have  hemorrhoids,  but 
while  waiting  to  see  him,  if  you  are  verj-  uncomfortable 
you  will  be  almost  certain  to  find  relief  in  lying  down  with 
your  hips  elevated  on  one  or  two  pillows ;  applying  an 
ice  bag  to  the  rectum,  or  ice-cold  cloths  or  cloths  wrung 


74         GETTING  READY  TO  BE  A  I\IOTHER 

from  equal  parts  of  water  and  witch  hazel.  Sometimes  the 
hemorrhoids  are  worse  during  the  first  few  days  after  the 
baby  is  born  but  as  a  rule  they  disappear  when  the  ultimate 
cause  is  removed,  which  in  this  case  is  pressure  made  by 
the  baby. 

Cramps  in  the  legs,  numbness  or  tingling  may  be  caused 
by  pressure  of  the  large,  heavy  uterus  upon  nerves  supply- 
ing the  lower  extremities.  Lying  down,  applying  heat  and 
rubbing  the  painful  parts  will  usually  relieve  the  discom- 
fort. 

Shortness  of  breath  is  sometimes  very  troublesome 
toward  the  end  of  pregnancy,  and  as  may  be  easily  under- 
stood, is  due  to  the  upward,  and  not  downward  pressure  of 
the  uterus.  For  this  reason  the  discomfort  is  made  worse  by 
lying  down  and  relieved  by  one's  sitting  up  or  being  well 
propped  up  on  pillows  or  a  back  rest. 

Vaginal  Discharge.  Although  the  normal  vaginal  dis- 
charge is  increased  during  the  later  months  of  pregnancy 
you  should  tell  your  doctor  if  your  discharge  is  very  free. 
You  should  not  take  douches  to  remove  it,  unless  your 
doctor  orders  tliem,  for  the  normal  discharge  gives  you  a 
certain  amount  of  protection  against  infection.  If  it  is  irri- 
tating or  causes  itching  or  burning  you  may  obtain  relief 
by  avoiding  the  use  of  soap  and  by  bathing  the  uncom- 
fortable parts  with  water,  containing  a  teaspoonful  of 
sodium  bicarbonate  to  a  pint,  or  with  olive  oil. 

Itching  of  the  skin  is  a  fairly  common  discomfort,  and 
is  possibly  a  result  of  irritating  material  being  excreted 
by  the  skin  glands  and  deposited  upon  the  surface  of  the 
body.  The  local  irritation  usually  may  be  relieved,  if  not 
very  severe,  by  bathing  the  uncomfortable  areas  with  the 
solution  of  sodium  bicarbonate  as  above,  or  a  lotion  con- 
sisting of  a  pint  of  lime  water,  half  an  ounce  of  glycerin 
and  thirty  drops  of  carbolic  acid.     It  is  a  good  plan,  also, 


CARE  OF  THE  F.AP.Y  BEFORE  HE  COMKS    75 

to  drink  more  water,  in  order  to  promote  tlie  aetivity  of 
the  skin,  kidneys  and  bowels,  and  thus  dilute  the  material 
that  may  be  responsible  for  tiie  itt-hing  and  increase  its 
elimination  tlirough  all  ehannels. 

Some  women  complain  of  discoinfort  caused  by  the 
stretching  of  the  skin  over  the  enlarged  abdomen.  There 
is  a  very  old  belief  that  rubbing  the  skin  with  oil  will  relieve 
this  sensation  and  also  prevent  the  appearance  of  the  pur- 
plish streaks  described  in  a  previous  chapter.  There  seems 
to  be  little  foundation  for  this  belief,  but  if  a  woman  fancies 
that  she  is  safer  and  more  comfortable  after  oiling  her  abdo- 
men, there  is  certainly  no  reason  why  she  should  not  do  so. 

HELPING  TO  PREVENT   COMPLICATIONS 

I  have  described  to  you  the  details  of  personal  hygiene 
which  3'our  doctor  is  likely  to  want  you  to  adopt  during 
your  months  of  expectancy,  and  some  of  the  simple  things 
that  you  may  do  to  relieve  minor  discomforts  when  they 
arise,  for  having  these  things  in  black  and  white  may  make 
the  whole  matter  a  little  easier  for  you. 

But  there  is  still  more  that  you,  can  do  to  lielp  the  doctor 
help  you.  You  can  tell  him  about  any  discomfort  or  any 
new  condition  that  appears,  and  follow  his  advice  instead  of 
talking  it  over  with  your  family  or  friends.  This  will  make 
it  possible  for  him  to  prevent  serious  complications  by 
treating  them  in  the  very  beginning. 

You  have  probably  learned,  in  one  way  or  another,  that 
the  complications  associated  with  childbirth  that  are  most 
serious  are  infections  (childbed  fever),  con\n.ilsions,  abor- 
tions or  miscarriages  and  severe  bleeding,  but  perhaps  you 
have  not  heard  that  you,  yourself,  can  help  greatly  in  the 
prevention  of  all  of  these  conditions,  in  your  own  ease,  and 
chiefly  by  little  more  than  exercising  good  common  sense. 


76  GETTING  READY  TO  BE  A  MOTHER 

Your  part  in  preventing  childbed  fever,  if  your  baby  is 
to  be  born  at  home,  lies  in  having  in  readiness  a  clean 
room,  sterile  sheets,  towels,  gauze  pads,  etc.,  as  will  be  de- 
scribed in  the  next  chapter. 

Concerning  the  other  complications  we  shall  say  a  word 
here. 

Convulsions.  You  can  do  a  great  deal  toward  preventing 
the  condition  that  causes  convulsions  by  following  the 
advice  about  your  personal  care  that  we  have  just  gone  over 
and  by  making  it  possible  for  the  doctor  to  treat  early 
symptoms  promptly.  In  fact,  after  looking  over  the  records 
of  many  thousands  of  mothers  who  have  had  prenatal  care, 
it  seems  almost  safe  to  say  that  the  expectant  mother  who 
follows  such  a  course  will  not  have  convulsions. 

One  of  the  commonest  of  tlie  early  symptoms  is  headache, 
sometimes  persistent  and  very  severe.  Others  which  you 
can  detect  are  blurred  vision,  spots  before  the  eyes,  dizzi- 
ness, vomiting  which  is  more  persistent  or  severe  than 
could  be  called  "morning  sickness,"  puffiness  under  the 
eyes  or  elsewhere  about  the  face  or  hands,  swelling  of  the 
feet  and  ankles  and  severe  pain  in  the  stomach.  It  might 
be  that  if  you  had  even  one  of  these  symptoms  your  doctor 
would  think  it  worth  while  to  put  you  to  bed  and  give  you 
nothing  but  milk,  or  only  water,  for  a  day  or  two,  not  be- 
cause you  were  sick,  but  to  keep  you  from  being  so,  on  the 
same  principle  that  you  darn  a  thin  place  in  a  stocking  to 
keep  a  hole  from  coming. 

In  any  event,  tell  your  doctor  about  the  symptoms  and 
let  him  decide  what  is  to  be  done,  for  therein  lies  your 
safety. 

Miscarriages.  The  question  of  abortions,  miscarriages 
and  premature  births  is  one  of  enormous  importance,  and 
one  about  which  there  is  a  good  deal  of  misunderstanding. 
As  to  the  meaning  of  the  terms,  many  women  are  puzzled 


CARE  OF  THE  BABY  B>EFORE  HE  COMES    77 

to  know  th^  difference  between  theui.  Doctors  are  not  likely 
to  use  the  word  miscarriage,  but  will  describe  as  an  abor- 
tion a  termination  of  pregnancy  which  occurs  before  the 
end  of  the  seventh  month  and  as  premature  labors  those 
occurring  from  that  time  until  the  expected  date  of  confine- 
ment. In  the  minds  of  lay  people,  however,  the  term 
abortion  is  often  associated  with  criminal  practice,  mis- 
carriage being  a  term  loosely  applied  to  all  births  occurring 
before  the  seventh  mouth,  while  the  premature  baby  is  the 
one  born  after  the  seventh  month  of  pregnancy  but  before 
the  expected  date  of  continement. 

Of  all  of  these  accidents,  abortions  are  the  most  frequent, 
though  in  the  nature  of  things  it  is  imposible  to  say  how 
often  they  occur.  They  sometimes  happen  so  early  in  preg- 
nancy that  the  expectant  mother  is  unaware  of  the  acci- 
dent ;  or  if  she  does  know  of  it  she  may  make  the  mistake 
of  taking  no  notice  of  it  or  regard  it  of  so  little  consequence 
that  she  does  not  consult  a  doctor.  Bvit  such  information 
as  is  available  suggests  that  at  least  one  out  of  every  five 
pregnancies  ends  in  abortion,  the  traged}^  of  this  being  that 
it  is  very  largely  a  preventable  disaster. 

Since  the  ovum  is  insecurely  attached  to  the  uterine  lining 
until  the  sixteenth  or  eighteenth  week,  an  abortion  is  more 
likely  to  occur  during  this  time  than  later,  while  of  this 
period,  the  second  and  third  months  seem  to  be  the  most 
perilous.  Abortions  are  less  likely  to  happen  during  first 
pregnancies  than  succeeding  ones  and  their  frequency  seems 
to  increase  with  the  number  of  pregnancies.  They  occur 
more  often  among  women  over  thirty-five  years  than  in 
younger  ones,  and  in  all  cases  are  most  likely  to  take  place 
at  the  time  when  menstruation  would  fall  due  were  the 
woman  not  pregnant. 

The  prevention  of  abortions  is  of  such  obvious  importance 
and  there  is  so  much  that  you  can  do  to  this  end,  that  we 


78         GETTING  READY  TO  BE  A  MOTHER 

shall  take  up  the  question  somewhat  at  len^h.  Preventive 
treatment  really  begins  very  early.  In  the  discussion  about 
menstruation  we  referred  to  .the  importance  of  finding  out 
the  cause  of  painful  periods,  in  the  interest  of  good  obstet- 
rics, since  inflammation  of  the  uterine  lining  or  a  mis- 
placed uterus  might  be  responsible  for  the  pain  and  if  neg- 
lected might  cause  an  abortion  later  on.  The  correction  of 
such  troubles,  no  matter  when  they  are  discovered,  is  an 
early  step  toward  preventing  abortions. 

But  after  pregnancy  has  actually  begun,  there  are  certain 
preventive  measures  which  have  proved  to  be  very  effective. 
A  woman  who  is  pregnant  for  the  first  time,  and  who,  there- 
fore, does  not  knoAV  whether  she  is  likely  to  have  an  abor- 
tion or  not,  should  avoid  such  risks  as  fatigue,  sweeping, 
lifting  or  moving  heavy  objects,  running  a  sewing  machine 
by  foot,  running,  jumping,  dancing,  traveling  or  any  action 
which  might  jar  or  jolt  her  during  the  first  sixteen  or 
eighteen  weeks. 

An  expectant  mother  who  has  had  an  abortion  will  have 
to  take  even  greater  precautions,  as  she  is  in  more  danger 
than  is  a  woman  who  has  not  had  this  experience.  It  is  of 
prime  importance,  to  begin  with,  that  she  have  the  cause  of 
her  previous  abortion  discovered,  and  if  possible  corrected. 
And  since  the  accident  is  most  likely  to  be  repeated  at  about 
the  same  time,  or  a  little  earlier,  in  each  succeeding  preg- 
nancy it  is  a  wise  precaution  for  the  expectant  mother  to 
remain  quietly  in  bed  for  at  least  a  week  before  and  after 
the  time  when  an  abortion  may  be  feared. 

Complete  rest  and  relaxation  are  such  effective  preventive 
measures  that  patients  with  a  tendency  to  have  abortions 
•who  have  been  willing  to  stay  in  bed  during  most  of  their 
pregnancy  have  sometimes  been  rewarded  by  going  through 
the  entire  period  and  in  the  end  giving  birth  to  a  normal, 
fully  developed  baby.     As  out-of-door  exercise  is  clearly 


CARE  OF  THE  BABY  BEFORE  HE  COMES  79 

impossible  in  such  cases,  it  is  iini)<)rlaiit  tlial  tlic  patient 
keep  her  room  very  well  ventilated  all  oi"  the  time,  and 
possibly,  under  the  doetor's  direction,  have  massage  or  bed 
exercises. 

The  marital  relation  is  usually  considered  inadvisable 
in  all  cases  after  the  eighth  month  of  pregnancy,  and  among 
women  who  have  had  aboi-tions  or  miscarriages  it  is  best 
omitted  throughout  the  entire  period.  This  is  particularly 
true  of  women  over  thirty-five  who  are  pregnant  for  the 
first  time. 

To  sum  it  up  in  a  word,  your  part  in  preventing  an  abor- 
tion or  miscarriage  after  pregnancy  has  begun,  consists 
largely  of  avoiding  fatigue ;  resting  when  tired ;  avoiding 
physical  shocks  such  as  blows  upon  the  abdomen,  jolts  or 
falls  particularl}'  during  the  first  sixteen  or  eighteen  weeks 
and  at  the  time  when  menstruation  would  ordinarily  occur 
if  you  were  not  pregnant,  and  avoiding  overwork  during 
the  later  weeks  of  pregnancy. 

The  common  symptoms  of  abortions  or  miscarriages  are 
bleeding,  often  accompanied  by  recurring  pain,  beginning 
in  the  small  of  the  back  and  finally  felt  as  cramps  in  the 
lower  part  of  the  abdomen.  Since  menstruation  is  sus- 
pended during  pregnancy  you  should  always  regard  bleed- 
ing or  a  bloody  discharge  as  a  symptom  of  a  possible  mis- 
carriage, whether  you  have  pain  or  not.  Fpon  its  appear- 
ance you  should  send  for  the  doctor,  go  to  bed  at  once  and 
keep  absolutely  cjuiet. 

Should  you  be  so  unfortunate  as  to  have  a  miscarriage, 
in  spite  of  all  your  precautions,  bear  in  mind  that  "you  will 
need  to  stay  in  bed  quite  as  long  afterwards  and  have  the 
same  care  as  though  you  had  given  birth  to  a  fully  devel- 
oped baby.  It  is  because  so  many  women  fail  to  appreciate 
this  that  abortions  and  i)rcmature  births  are  often  followed 
by  ill  health  and  invalidism.     Under  jirojier  care,  an  abor- 


80         GETTING  READY  TO  BE  A  MOTHER 

tion  or  premature  labor  is  not,  of  itself,  any  more  serious 
for  a  woman  than  a  normal  delivery. 

Bleeding  from  the  vagina,  or  a  sudden  increase  in  the 
size  of  the  abdomen  with  perspiration  and  a  sudden  feeling" 
of  faintness,  may  be  the  beginning  of  severe  bleeding,  or 
hemorrhage,  from  any  one  of  a  number  of  causes,  and  in 
such  a  case  the  expectant  mother  should  notify  her  doctor, 
go  to  bed  at  once  and  keep  quiet  until  he  arrives. 

Summing  up  the  whole  question  of  preventing  complica- 
tions, we  find  that  the  following  symptoms  may  be  forerun- 
ners of  serious  trouble  and  therefore  should  be  watched  for 
and  reported  to  the  doctor  as  soon  as  they  are  noticed : 

1.  Persistent  or  severe  vomiting. 

2.  Persistent  or  severe  headache. 

3.  Dizziness. 

4.  Blurred  vision  or  the  appearance  of  black  spots  before  the 

eyes. 

5.  Puffiness  under  the  eyes,  or  elsewhere  about  the  face. 
G.  Swelling  of  the  feet,  ankles  or  hands. 

7.  Sharp  pains,  particularly  in  the  stomach. 

8.  Prolonged  failure  to  feel  the  baby's  movements  after  they 

have  once  been  felt. 

9.  Bleeding,  or  a  bloody  discharge. 

10.  Pain  in  the  small  of  the  back  followed  by  cramp-like  pains 

in  the  abdomen,  before  the  expected   date  of  confine- 
ment. 

11.  Unwarranted  mental  depression,  anxiety  or  apprehension. 

These  are  generally  accepted  as  the  danger  signs  of 
pregnancy,  any  one  of  which,  alone  or  in  combination  with 
one  or  more  of  the  others,  is  of  importance.  In  addition  to 
these  it  really  is  important  that  you  talk  to  your  doctor  or 
your  nurse  freely  if  you  are  feeling  worried  or  depressed 
about  anything  at  all.  Sometimes  one  feels  blue  without 
knowing  why,  and  if  you  should  feel  so  during  your  preg- 


CARE  OF  THE  BABY  BEFORE  HE  COMES  81 

nancy  you  should  not  keop  it  to  yourself  but  talk  it  over 
witli  your  doctor  or  your  nurse. 

When  all  is  said  and  done,  what  we  want  for  each  expect- 
ant niotiier  is  little  more  than  that  she  shall  live  a  nor- 
mal, regular,  wholesome  life;  that  she  shall  be  able,  and 
w'hat  is  of  equal  importance,  be  willing  to  weave  into  her 
everyday  life  the  principles  of  personal  care  which  every 
one  should  adopt ;  that  she  shall  watch  and  be  watched  for 
symptoms  of  complications  throughout  the  entire  period  of 
pregnancy,  in  order  that  they  may  be  detected  early, 
speedily  treattnl  and  serious  troubles  thereby  prevented. 

The  adoption  of  such  simple  precautions  will  pave  the 
highroad  to  health  and  happiness  for  yourself  and  your 
baby. 


.«nf»sr* 


CHAPTER  VI 
MAKING  READY  FOR  THE  BABY 

In  making  ready  for  the  actual  arrival  of  the  baby  there 
are  several  factors  to  consider,  chief  among  them  being  the 
doctor;  the  nurse;  the  place  where  the  baby  is  to  be  born; 
the  room  he  is  to  occupy  and  an  equipment  which  will 
facilitate  the  care  of  yourself  and  the  baby,  at  the  time 
of  his  birth  and  afterwards. 

Of  course  you  have  long  since  placed  yourself  under  a 
doctor's  care,  so  that  is  settled.  If  you  are  in  the  care  of 
a  privately  engaged  physician,  he  will,  in  all  probability 
tell  you  his  wishes  in  regard  to  your  engaging  a  nurse. 
She  should  be  satisfactory  to  both  you  and  the  doctor  from 
the  standpoint  of  training  and  professional  fitness  as  well 
as  her  personality.  The  selection  of  the  nurse,  therefore, 
should  be  made  in  cooperation  with  your  doctor.  It  is  wise 
to  engage  her  during  the  early  part  of  your  pregnancy 
both  to  insure  your  securing  the  one  that  you  and  the  doctor 
want  especially,  and  to  have  that  much  of  the  preparation 
off  your  mind.  It  is  usually  a  good  plan  to  engage  the 
nurse  to  hold  herself  in  readiness  to  respond  to  your  call 
at  any  time  after  two  weeks  before  the  expected  date  of 
your  confinement.  Quite  reasonably,  if  she  is  obliged  to 
give  up  or  refuse  an  engagement  in  order  to  hold  herself 
available  for  you,  from  a  given  date,  she  will  do  so  at  your 
expense.  Try  to  arrange  to  have  the  nurse  stay  with  you 
for  six  weeks  after  the  baby  is  born,  even  though  this  in- 
volves considerable  financial  sacrifice  on  your  part.     Of 

82 


MAKING  READY  FOR  THE  HABY     8.} 

course  if  3'oii  can  afford  to  keep  lier  still  longer,  so  niut'h 
the  better. 

All  of  this  is  in  case  you  are  in  the  care  of  a  privately 
engaged  phj-sician  and  are  to  have  a  special  nurse.  If 
you  are  being  cared  for  during  pregnancy  by  doctors  and 
nurses  connected  with  a  dispensary,  health  center  or  pre- 
natal clinic,  they  will  advise  with  you  about  your  nursing 
care  at  the  time  of  confinement  and  afterwards. 

The  next  question  to  consider  is  whether  the  baby  is  to 
be  born  at  j^our  home  or  in  a  liospital.  The  doctor  who  is 
advising  you  will  have  his  wishes  on  this  subject,  too,  and  as 
they  are  entirely  in  your  interest,  you  will,  of  course,  do 
as  he  advises.  You  will  be  likely  to  find  that  for  the  birth 
of  the  first  baby  he  will  want  you  to  go  to  a  hospital,  if 
there  is  a  good  one  available ;  also  if  you  have  had  any 
symptoms  of  complications  during  this  pregnancy  or  diiifi- 
culty  with  previous  labors. 

If  you  are  going  to  a  hospital  you  or  your  doctor  will 
make  the  necessary  arrangements  about  j^our  room,  well  in 
advance  of  the  date  upon  which  you  expect  to  go,  in  order 
to  feel  sure  that  a  room  will  be  ready  for  you. 

It  sometimes  happens,  that  for  a  varietj^  of  reasons  it  is 
nearly  or  quite  impossible  for  the  expectant  mother  to  go 
to  a  hospital,  or  that  her  doctor  is  entirely  Avilling  that  she 
shall  be  confined  at  home.  If  it  is  decided  that  you  are 
to  remain  at  home,  it  will  be  possible,  with  a  little  planning 
and  effort  on  your  part,  to  imitate  very  nearly  in  your  own 
home  the  advantages  which  are  offered  by  a  hospital. 

You  will  remember  that  in  the  last  chapter  I  mentioned 
childbed  fever  as  being  one  of  the  serious  complications, 
associated  Avith  childbirth,  that  could  be  prevented  by  care- 
ful work.  In  the  old  days,  when  the  importance  of  cleanli- 
ness was  not  appreciated,  this  fever  was  very  common  in 
maternity   hospitals,   but   nowadays   it   seldom   occurs   in 


84    GETTING  READY  TO  BE  A  MOTHER 

well  conducted  institutions  because  the  doctors  and  nurses 
know  how  to  do  clean  work  and  also  because  they  have 
clean  things  to  work  with.  So  if  you  are  to  be  attended  at 
home  by  a  good  doctor  and  a  good  nurse  you  may  make  the 
conditions  of  your  confinement  practically  ideal  by  provid- 
ing a  clean  room  and  such  an  outfit  of  sterile  sheets,  towels, 
dressings  and  certain  other  articles  as  would  be  available 
for  their  use  in  a  hospital. 

Suppose  we  settle  tlie  question  of  the  rooms  first. 

It  is  a  very  imi)ortant  one  but  need  not  be  the  bugbear 
that  some  people  think  it  is.  In  all  probability  you  will 
have  no  choice  as  to  a  room  for  yourself  and  will  have  to  use 
the  one  you  ordinarily  occupy.  Should  you  have  a  choice, 
however,  it  will  be  well  to  select  one  that  is  cool  and  shady, 
if  the  baby  is  coming  during  the  summer,  but  one  that  is 
bright  and  sunny  for  occupancy  during  most  of  the  year. 
It  should  be  conveniently  near  a  bathroom,  if  possible  ;> 
have  an  adjoining  room  for  the  nurse  and  one  near  by  for 
the  baby. 

The  ideal  to  work  toward  is:  A  room  with  a  washable 
floor  with  small,  light  rugs ;  freshly  laundered  curtains  at 
the  windows  but  no  heavy  draperies;  a  single  brass  or 
iron  bedstead,  about  thirty  inches  high,  with  a  firm  mat- 
tress, and  so  placed  as  to  be  accessible  from  both  sides  and 
with  the  foot  in  a  good  light,  either  by  day  or  night ;  a  bed- 
side table  and  two  others  (folding  card  tables  are  a  great 
convenience);  a  bureau;  a  washstand,  unless  there  is  a 
bathroom  on  the  same  floor;  one  or  two  comfortable  chairs, 
two  or  three  straight  chairs  and  a  couch  or  chaise  longue, 
all  of  which  should  be  of  wood  or  wicker  or  covered  with 
freshly  laundered  chintzes. 

Between  such  a  room  as  this  and  the  one  that  must  be 
used  there  may  be  a  wide  difference,  but  it  will  be  worth 
while  to  approach  this  standard  as  nearly  as  possible.    It  is 


MAKING  READY  FOR  THE  BABY  85 

not  necessary  to  make  the  room  bare ;  in  fact,  it  should  be 
as  cheerful  and  pretty  as  is  compatible  with  clfanliness. 
There  is  no  objection  to  pictures  on  the  walls,  but  the 
room  should  be  free  from  useless,  small  articles  which  are 
likely  to  be  dust  (•at<-lM'rs,  jrive  the  nurse  unnecessary'  work 
and  occupy  space  needed  for  other  tilings. 

The  room  should  be  given  a  thorough  house-cleaning 
about  two  weeks  before  the  baby  is  expected.  If  there  is  a 
carpet  on  the  floor  that  cannot  be  taken  up  conveniently, 
it  might  be  well  to  have  in  readiness  a  large  canvas  or 
rubber  or  an  abundance  of  newspapers  to  protect  the  floor 
near  tlie  bed.  If  the  bed  is  low.  the  attentions  of  the  doctor 
and  nurse  will  be  made  much  easier  if  you  have  ready  four 
solid  blocks  of  wood,  of  the  same  size,  upon  which  to  elevate 
the  bed,  after  the  casters  have  been  removed.  The  blocks 
should  be  of  such  a  size  as  to  bring  the  height  of  the  bed 
up  to  thirty  inches.  And  it  is  important,  too,  to  have  a  large 
board,  or  table  leaves,  at  hand,  to  slip  under  the  mattress 
to  make  it  firm,  particularly  if  the  bed  is  soft  or  sinks  in  the 
middle. 

The  chief  requisites  for  the  baby's  room  are  that  it  may 
be  well  ventilated  and  easily  cleaned.  The  floor  should  be 
of  hard  wood,  or  covered  with  linoleum,  in  order  that  it  may 
be  wiped  up  with  a  damp  cloth  every  day.  and  the  walls 
should  be  freshly  papered,  or,  better  still,  painted.  As  bright 
light  and  glare  are  bad  for  the  baby  the  walls  would  better 
be  of  a  soft  shade,  such  as  gra.vish  green  or  blue,  than 
white,  and  there  should  be  dark  shades  at  the  Avindows,  in 
order  that  the  room  may  be  darkened  at  will. 

The  furnishings  may  consist  of  a  brass  or  enameled  crib, 
with  a  hair  mattress ;  a  chest  of  drawers ;  a  low  straight 
chair  and  low  rocker,  both  without  arms,  and  a  low  table 
for  the  baby's  toilet  articles.  An  ordinary  kitchen  table, 
enameled  and  with  the  legs  sawed  off,  serves  admirablv.    All 


86         GETTING  EEADY  TO  BE  A  MOTHER 

of  the  furniture  should  have  smooth,  washable  surfaces, 
such  as  hard  wood  or  enamel,  and  the  walls  should  be 
free  from  pictures,  for  the  baby's  room  will  have  to  be 
kept  scrupulously  clean  and  free  from  dust. 

So  much  for  the  rooms. 

When  it  comes  to  tlie  question  of  providing  the  outfit  to 
be  used  in  your  personal  care,  the  matter  of  nightgowns 
and  the  like  will  be  determined  by  your  tastes  and  your 
means,  rather  than  by  specific  needs.  But  six  or  eight 
nightgowns,  a  warm  bed  jacket  if  the  weather  is  cool,  a 
dressing-gown  and  a  pair  of  slippers,  will  prol)ably  be 
enough  to  keep  you  fresli  and  comfortable,  so  far  as  these 
things  are  concerned,  whether  you  are  in  a  hospital  or  at 
home. 

But  the  preparation  of  necessary  dressings  and  other  arti- 
cles for  a  home  confinement  is  a  different  matter  and  you 
should  learn  the  wishes  of  your  doctor  concerning  them. 

If  his  instructions  are  not  specific,  you  may  find  that  the 
following  lists  will  be  helpful  guides  in  assembling  an  equip- 
ment which  will  prove  adequate  to  meet  the  ordinary  re- 
quirements of  a  home  confinement.  ]\Iost  of  the  articles 
listed,  or  satisfactory  substitutes,  are  to  be  found  in  the 
average  household,  but  they  should  be  gotten  together  in 
one  place  so  as  to  be  ready  at  a  moment's  notice. 

For  the  Confinement  and  Your  Own  Care: 

Plenty  of  sheets,  pillow  cases  and  towels. 

4  sanitary  belts. 

1  piece  rubber  sheeting-  or  oil  cloth,  1  x  ly?  yards. 

1  piece  rubber  sheeting-  or  oilcloth,  2x11/2  yards. 

Two  or  three  dozen  safety  pins. 

Hot  water  bag  with  flannel  cover. 

1  two-quart  fountain  syringe. 

1  douche  pan. 

1  bed  pan. 


MAKING  READY  FOR  THE  BAliV  87 

2  covered  slop  jars  or  coviMod  i)ails. 

3  basins,  about  Ki,  14  and  12  inches  in  diameter. 

2  stiff  nail  brushes,  nail  scissois  and  tile  or  oraiiue  stick. 

3  agate  or  enamel  pitchers,  holdiui;-  at  least  1  (juart  each. 
Medicine  glass. 

Medicine  dropper. 

2  bent  glass  diiiiking  tul)es. 

100  bichlorid  tablets. 

•i  ounces  chloroform. 

4  ounces  boric  acid  powdci". 
4  ounces  green  soaj). 

1  pint  grain  alcohol. 

Small  jar  of  vaselin  to  be  sterilized. 

Lard,  olive  oil,  vnselin  or  albolene  to  nil  llic  baby. 

Roll  of  adhesive  jilaster,  1  inch  wide. 

One  package  of  absorbent  cotton. 

One  clinical  thermometer. 

In  addition  to  these,  a  certain  snpply  of  sterile  dressings 
will  be  needed.  Complete  ontfits  of  such  dressings,  ster- 
ilized and  ready  for  nse,  may  be  obtained  from  any  one  of  a 
number  of  firms,  of  which  your  doctor  will  know;  or  they 
may  be  prepared  by  the  nurse,  or  you  yourself  may  prepare 
and  sterilize  the  following : 

One  dozen  towels. 

Three  sheets. 

Five  or  six  dozen  sanitary  pads,  about  10  inches  long  and  4  inches 

wide,  made  of  gauze  and  cotton  batting  with  a  top  layer  of 

absorbent  cotton. 
Two  to  four  bed  pads,  about  30  inches  square  and  4  inches  thick, 

made  of  gauze  and  cotton  waste  or  cotton  batting  with  a  top 

layer   of    absorbent    cotton;    or    of    news)iapers    covered    Avith 

muslin. 
One  pair  of  leggings  made  of  canton-  or  outing-fiainiel,   either 

loose  fitting  hose  reaching  to  the  thighs  or  a  yard  square  folded 

diagonally  and  stitched  on  one  side.     See  Fig.  16. 


88  GETTING  READY  TO  BE  A  MOTHER 

Five  or  six  dozen  gauze  sponges,  made  by  folding  pieces  of  gauze 

18  inches  square  into  small  pads  with  all  raw  edges  inside. 
Two  or  three  dozen  gauze  squares,  4  inches  square. 
Four  or  five  dozen  cotton  pledgets,  or  wads  of  absorbent  cotton 

about  the  size  of  an  egg  with  the  edges  dra\vn  together  between 

thumb  and  finger  and  twisted  into  a  spiral. 
Six  pieces  of  bobbin  or  narrow  tape,  9  inches  long,  to  tie  the 

baby's  cord. 


Fig.  16. — Two  types  of  easily  made  lejjgings,  suitable  for  use  at  the 
baby's  birth. 

To  make  these  supplies  you  will  need  about  four  pounds 
of  absorbent  cotton,  6  or  8  packages  of  cotton  batting,  and 
possibly  40  yards  of  gauze  in  addition  to  cotton-flannel 
for  the  hose. 

In  preparing  the  dressings  for  sterilization,  you  may 
divide  them  into  packages  as  follows:  The  sheets  in  one 
package;  6  towels  in  a  package;  6  sanitary  pads  in  a  pack- 


MAKING  READY  FOR  TUE  liAliV  89 

age ;  2  delivery  pads  in  a  package ;  the  gauze  squares  in  two 
packages;  the  leggings  in  one  package;  tlie  bobbin  in  one 
package.  The  sponges  and  pledgets  should  be  j)nt  up  in 
bags  or  small  pillow  eases,  2  or  3  dozen  in  a  bag.  Wrap  each 
package  in  heavy  muslin,  either  new  or  old,  using  pieces 
large  enough  to  well  protect  the  contents  from  contamina- 
tion by  dust  or  handling,  tie  them  securely  with  string  and 
sterilize  as  follows:  Fill  a  wash  boiler  about  a  (piarter  full 
of  water  and  fashion  a  hammock  by  securely  tying  a  towel 
or  strip  of  muslin  to  the  handles  at  each  end  and  allowing 
it  to  hang  so  that  the  bottom  of  the  hammock  is  about 
halfway  down  in  the  boiler.  As  the  weight  of  the  dressings 
makes  the  hammock  sag  low  in  the  middle  it  is  a  wise  pre- 
caution to  place  a  rack  or  support  of  some  kind  in  the  bot- 
tom of  the  boiler,  to  hold  the  dressings  well  above  the 
bubbling  water,  at  the  point  where  they  hang  lowest.  Pile 
the  dressings  into  the  hammock,  cover  the  boiler  tightly  and 
keep  the  water  boiling  vigorously  for  an  hour ;  dry  the 
packages  in  the  sun,  or  by  placing  them  in  the  oven  for  a 
few  moments,  taking  care  that  they  are  not  loosened  or 
opened,  and  at  the  end  of  twenty-four  hours  repeat 
the  steaming  and  drying  process,  w^ap  the  packages  in  a 
clean  sheet  and  put  them  in  a  drawer  or  covered  box  where 
they  maj'  remain  undisturbed  until  needed.  The  nail 
brushes,  douche  pan  and  fountain  syringe  may  be  wrapped 
in  muslin  and  sterilized  in  the  same  way,  or  the  nurse  may 
boil  them  when  the  time  comes  to  use  them. 

Bed  pads  made  of  newspapers  offer  excellent  protection 
and  are,  of  course,  less  expensive  than  those  made  of  cotton. 
They  consist  of  six  or  eight  thicknesses  of  newspaper  opened 
out  to  the  full  size  of  the  page  and  covered  with  a  piece  of 
freshly  laundered  muslin  which  is  folded  over  the  edges 
and  basted  in  place  or  held  with  safety-pins,  as  shown  in 
Fig.   17,     These   pads  may  be  made  virtually  sterile  by 


90 


GETTING  READY  TO  BE  A  MOTHER 


ironing  them  on  the  muslin  side  with  a  very  hot  iron,  folding 
the  ironed  surface  inside  without  touching  it,  ironing  the 
outside  after  it  is  folded  and  wrapping  the  pads  in  a  clean 
sheet  or  muslin,  also  recently  ironed,  and  putting  them  away 
with  the  other  dressings,  in  a  place  protected  from  dust. 


Fig.  17. — Eeverse  side  of  pad  made  of  newspapers  and  old  muslin 
to  protect  bed  during  a  home  confinement.  Tf  muslin  is  held  in  place 
with  safety  pins  it  may  be  removed  easily,  washed  and  used  for  an- 
other pad.     (By  courtesy  of  the  Maternity  Centre  Association.) 


Baby  Clothes.  In  planning  the  baby  clothes,  there  are  a 
few  general  principles  to  bear  in  mind  that  are  of  con- 
siderable importance  to  the  baby's  welfare.  His  health 
actually  may  be  injured  by  having  his  clothes  too  warm 
or  not  warm  enough,  and  also  if  they  are  tight  enough  to 
bind  or  constrict  any  part  of  his  body  or  so  ample  as  to 
form  bunches  and  wrinkles  which  will  make  him  uncom- 
fortable and  restless. 


MAKTXCi  KKADV  FOR  THE   I'.AIIV  f)l 

To  bo  entirely  satisfactory  his  clothes  should  he  sim|)le  in 
design  and  so  made  as  to  slip  on  easily,  fit  loosely  and  at  the 
same  time  smoothly ;  the  materials  should  be  soft,  light 
and  porous.  Complete  outfits  of  baby  clothes  may  be  bought 
outright,  but  few  expectant  mothers  are  willing  to  forego 
the  sheer  ecstasy  of  fashioning  the  little  garments  them- 
selves, while  they  dream  dreams  of  the  ba])y  who  is  to  wear 
them.  The  following  list  of  garments  will  meet  the  baby's 
needs,  and  those  which  you  may  make  are  really  very 
simjile: 

Two  to  four  dozen  (liajiers,  about  IS  inches  square. 

Three  flannel  bands  (i  inches  wide  and  27  inches  long,  iin- 

hemme<l. 
Three  knitted  bands  with  shoulder  straps. 
Three  shirts,  infants',  size  2,  of  cotton  and  wool,  silk   and 

wool  but  not  all  wool. 
Four  wool  and  cotton  flannel  jietticoats. 
Four  wool  and  cotton  flannel  nightgowns. 
Six  thin  white  cotton  sli])s,  or  dresses. 
Flannel  wrapper  or  a  yard  square  of  flannel  for  extra  wrap 

in  cool  room. 
Cloak  and  cap  or  other  wrap  for  out  door  use  in  cool  weather. 

Let  US  take  these  up  in  turn. 

The  diapers  may  be  of  any  soft,  absorbent,  looseh'  woven 
material,  such  as  cheesecloth,  stockinette,  bird's-eye,  cot- 
ton fiaunel  or  thin  Turkish  toweling,  single  or  double  thick- 
ness, according  to  the  weight  of  the  material  used,  and 
about  18  inches  square  when  hemmed. 

The  first  bands  are  of  cotton  and  wool  flannel,  torn 
straight  across  the  width  of  the  material  in  6-inch  strips 
and  left  unhemmed.  After  the  cord  separates,  this  band 
is  usually  replaced  by  a  knitted  band  with  shoulder  straps. 

The  shirts  should  have  high  necks  and  long  sleeves,  come 
well  down  over  the  hips  and  open  all  the  way  down  the 


92 


GETTING  READY  TO  BE  A  MOTHER 


front.  They  should  be  of  cotton  and  wool  or  silk  and  wool 
but  not  all  wool  as  this  is  too  warm.  During  very  warm 
weather  the  shirts  shojild  be  of  thin  cotton  or  silk.  It  is 
better  to  start  with  size  2  as  the  smaller  size  will  soon  be 
outgrown. 


Fig.  18. — Pattern  for  baby's  petticoat  (shown  in  C.  Fig.  20)  re- 
quiring %  yard  of  material  one  yard  wide.  The  cotton  dress  {A) 
and  flannel  nightgown  (B)  in  Fig.  20,  may  be  made  from  this  pattern 
with  the  addition  of  straight  sleeves. 


The  petticoat  is  a  very  important  item  in  the  baby's 
wardrobe,  for,  helping  as  it  does  to  keep  his  body  evenly 
warm,  it  is  worn  constantly  except  during  verj^  warm 
weather.  It  should  be  a  straight  little  slip,  about  27  inches 
long,  hanging  from  the  shoulders,  made  entirely  of  flannel, 
without  the  broad  cotton  waistband  that  has  tortured  so 
many  babies  in  days  gone  by. 


MAKING  RExVDY  FOR  THE  BABY 


93 


The  chief  purpose  of  the  dresses  or  slips  is  to  keep  the 
petticoats  clean  and  add  to  the  daintiness  of  the  baby's  at- 
tire and  they  arc  made,  therefore,  of  very  thin,  soft  cotton 
or  linen  material.  They  arc  made  from  the  same  pattern 
as  the  petticoats,  except  tliat  they  have  sleeves  and  these 


FoU    o\    m^t 


Fig.  19. — Pattern  for  kimono-style  dress  or  nightgown,  shown  in  E, 
Fig.  20,  and  requiring  l^^  yards  of  material  27  inches  wide. 

may  be  set  in  or  cut  out  in  one  piece  with  the  rest  of  the 
garment  like  kimono  sleeves,  as  in  Fig.  19. 

The  nightgowns  are  made  like  the  slips,  hut  of  the  same 
part  wool  flanuel  as  that  used  for  the  petticoats. 

The  petticoats,  slips  and  nightgowns  should  all  open 
down  the  back  and  may  be  fastened  with  either  tapes  or 
buttons  and  buttonholes.  These  fastenings  present  about 
equal  advantages  but  there  is  perhaps  a  slight  preference 


MAKIXfJ  READY  FOR  THE  liAP.Y  0.') 

for  buttons  as  babies  sonietinu's  tangle  their  tingers  in  tapes 
or  get  them  in  their  mouths. 

A  satisfactory  little  wrap  to  use  at  first  may  be  made 
from  a  yard  square  of  soft,  warm  material  with  a  hood 
formed  of  one  corner  by  running  tapes  through  casings. 

Patterns  for  these  baby  clothes  may  be  obtained  from 
two  or  three  of  the  large  pattern  concerns,  or  you  may  cut 
them  out,  yourself,  by  using  Figs.  18  and  19  as  guides, 
while  Fig.  20  shows  how  the  various  little  garments  look 
when  finished. 

The  question  of  socks  for  the  new  baby  is  one  upon  which 
doctors  hold  different  opinions,  some  believing  that  the 
warmth  provided  by  the  petticoat  is  sufficient ;  others,  that 
there  is  an  advantage  in  the  extra  protection  afforded  by 
socks,  so  you  would  better  learn  the  wishes  of  your  own 
doctor  in  this  connection. 

Additional  Articles  Which  Are  Needed  or  Useful  in  the 
Care  of  the  Baby : 

Bath  tub,  tin,  enamel,  agate  or  rubber. 

Drying  frames  for  shirts  and  stockings. 

Rubber  bath  apron. 

Flannel,  or  Turkish  toweling  bath  apron. 

Low  chair  without  arms. 

Low  table. 

Screen  to  protect  baby  durino-  bath. 

Rack  upon  which  to  hang  clothes  to  warm  during  bath. 

Scales,    with    beam    and    basket    or   scoop,    not    the    spring' 

variety. 
Hot  water  bag  and  cover. 
Crib,  basket  or  box,  to  be  used  as  bed. 
Folded  felt  pad,  blanket  or  hair  pillow  for  mattress. 
Rubber  or  oilcloth  to  cover  mattress. 
6  crib  sheets. 

1  thermometer. 

2  crib  blankets. 


96 


GETTING  READY  TO  BE  A  MOTHER 


Soft  towels  and  wash  cloths. 

An  old  blanket  to  be  used  for  bath  blanket. 

3  or  4  dozen  safety  pins,  assorted  sizes. 

Castile  soap. 

Boric  acid  powder. 

Olive  oil  or  albolene. 

Absorbent  cotton  pledgets,  preferably  sterile. 

Enamel  pail  and  cover. 

The  giving  of  the  baby's  daily  bath,  after  he  comes,  will 
be  greatly  simplified  if  you  will  assemble  beforehand  and 


Fig.  21. — Baby  's  toilet  tray  equipped  with  jelly  glasses,  bottles,  cellu- 
loid hair  receiver  for  t-otton,  and  a  soap  dish,  as  follows: 


1.  Safety-pins  sticking  in  cake 

of  soap. 

2.  Jar  for  sterile  nipples. 

3.  Jar  of  sterile  water. 

4.  Jar  of  boracie  acid  solution. 

5.  Nursing  bottle. 

6.  Sterile  water  to  drink. 


7.  Nursing  bottle  for  water. 

8.  Small  tooth  pick  swabs. 

9.  Liquid  iJetrolatuni. 

10.  Gauze  mouth  swabs. 

11.  Absorbent  cotton. 

12.  Soap. 


(By  courtesy  of  the  Maternity  Centre  Association.) 


keep  in  readiness  on  a  tray  or  small  table,  all  of  the  things 
which  are  to  be  used  each  time.  Dainty  little  outfits  for  this 
purpose  may  be  bought,  or  you  may  arrange  an  entirely 
satisfactory  one  from  jars  and  bottles  to  be  found  in  the 
house,  as  suggested  in  Fig.  21. 


MAKING  READY  FOR  THE  liAHV  [)7 

The  above  lists  of  dressings  and  articles  to  be  used  in  the 
care  of  both  mother  and  baby  can  be  considerably  modified, 
according  to  one's  tastes  and  means,  and  still  be  satisfactory. 
They  merely  represent  a  fair  average  of  what  has  been 
found  adeciuatc  to  meet  the  usual  needs  of  the  mother  and 
baby  at  home. 

It  will  be  a  good  plan  for  you  to  have  in  readiness,  by 
about  the  end  of  the  seventh  calendar  month,  all  of  the 
dressings  and  other  articles  to  be  used  during  the  confine- 
ment. This  is  in  case  you  should  have  a  premature  labor, 
for  which  the  same  dressings  are  needed  as  in  a  normal  de- 
livery. The  baby 's  clothes,  however,  will  be  in  time  if  they 
are  ready  by  the  end  of  the  eighth  month.  A  baby  born 
before  this  time  would  probably  be  so  frail  that  he  would 
be  wrapped  in  cotton  at  first,  instead  of  being  dressed  in  the 
clothes  ordinarily  prepared  for  a  fully  developed  baby. 

If  you  will  make  such  preparations  for  the  baby's  arrival 
as  I  have  suggested,  you  will  be  doing  a  great  deal  toward 
securing  his  safety  and  well-being,  as  well  as  your  own. 


CHAPTER  VII 
THE  BABY'S  ARRIVAL 

During  the  past  nine  months  you  have  had  the  happiness 
of  guarding  the  little  life  within  you  and  of  making  soft, 
warm  garments  to  have  in  readiness  for  the  baby  when  he 
comes.  You  have  prepared  your  room  and  his ;  folded  up 
the  packages  of  gauze  and  cotton  and  prepared  all  sorts 
of  other  things  to  be  pressed  into  service  upon  the  baby's 
arrival,  and  through  it  all  you  have  dreamed  and  planned 
and  built  the  loveliest  of  castles  in  Spain. 

And  now,  at  last,  the  baby  is  coming ! 

It  almost  takes  your  breath  away  to  realize  it  after  all 
those  months  of  waiting  and  dreaming,  and  though  it 
scarcely  seems  possible,  the  waiting  is  almost  over. 

This  same  w'aiting  grows  very  hard  toward  the  end  for 
you  are  tense  with  expectation  and  suspense.  The  hours 
and  days  seem  endlessly  long,  as  they  pass  without  giving 
the  looked-for  signs  that  the  baby  has  started.  Yovi  find 
it  very  hard  not  to  grow  discouraged  and  impatient,  he 
seems  so  long  in  coming.  Your  physical  discomfort  is  ag- 
gravated by  the  greater  pressure  made  by  the  baby  during 
this  period,  and  you  cannot  get  away  from  it  day  or  night. 
The  desire  to  urinate  is  almost  constant ;  your  back  aches ; 
your  feet  feel  heavy  and  swollen  and  the  baby  disturbs 
your  nights  by  his  increasingly  vigorous  kicking. 

But  this  does  not  last  long,  so  try  to  minimize  the  fatigu- 
ing effects  of  it  all  by  resting  and  sleeping  as  much  as 
possible  during  the  day.     The  time  does  slip  by  and  the 


THE  BABY'S  ARRIVAL  99 

baby  really  does  come  and  you  don't  want  to  be  tired  before 
the  big  event. 

The  miracle  of  the  baby's  origin  at  the  moment  of  con- 
ception; of  his  growth  and  the  development  of  the  intri- 
cate parts  of  his  little  body,  is  equaled  only  by  the  miracle 
of  his  birth — his  separating  from  your  protecting  body  and 
coming  into  the  world  as  a  new  human  being  when  the  time 
comes  that  he  is  able  to  exist  separately  and  independently. 

Since  very  early  in  pregnancy,  you  will  remember,  your 
uterus  has  been  growing  alternately  hard  and  soft  as  the 
muscles  have  contracted  and  relaxed.  But  these  contrac- 
tions have  been  as  painless,  and  so  far  as  we  know,  as 
fruitless  as  the  contractions  of  a  boy's  biceps  as  he  clenches 
his  fist  and  produces  a  luird  lump  on  his  arm. 

But  when  the  baby  is  ready  to  take  up  his  life  among 
the  rest  of  us  human  beings,  the  contractions  of  your  uter- 
ine muscles  are  altered  in  such  a  manner  that  you  gradually 
become  conscious  of  them  and  they  become  so  purposeful 
that  they  are  able  slowly  but  steadily  to  force  the  baby 
down  through  that  narrow  part  of  the  pelvis  called  the  inlet, 
through  the  cervix,  and  finally  out  into  the  world. 

Since,  at  the  proper  time  you  will  be  able  to  help  these 
altered  muscular  contractions  to  accomplish  their  high  pur- 
pose, you  will  want  to  watch  their  progress,  with  your 
mind's  eye,  as  far  as  possible. 

Recall,  for  a  moment,  the  fact  that  the  baby  is  contained 
in  a  sac  of  fluid  in  the  cavity  of  the  uterus,  above  the  cer- 
vix ;  that  the  cervix,  below,  is  a  canal  drawn  in  tightly  at 
the  upper  end,  or  internal  os,  and  also  at  the  lower  end,  or 
external  os. 

Quite  evidently  after  the  baby's  head  has  been  squeezed 
through  the  pelvic  inlet  by  pressure  of  the  uterine  contrac- 
tions, the  cervix  must  open  widely  in  order  that  he  may 
pass  through  it,  too.     And  so  Nature  gradually  stretches 


100        GETTING  READY  TO  BE  A  MOTHER 

this  narrow  canal  by  using  the  loAvermost  part  of  the  bag 
of  waters  as  a  water-wedge  and  forcing  it  down  into  the  in- 
ternal OS,  a  little  farther  with  each  pain.  The  opening 
grows  wider  and  wider  as  the  bag  of  waters  is  pressed 
farther  and  farther  down  into  the  cervical  canal,  Avhich  also 
widens  slowly,  and  finally  the  external  os,  too,  is  stretched 
wide  open  by  the  water-wedge.  Fig.  22  shows  how  the  cer- 
vix looks  with  the  bag  of  waters  pressed  against  the  upper- 
opening  and  how  the  entire  canal  is  gradually  dilated  by 
this  wedge,  as  it  is  pressed  downward. 

As  you  doubtless  know,  the  process  of  your  baby's 
emergence  into  the  world  and  separation  from  your  body  is 
termed  labor.  The  onset  of  labor  is  usually  marked  by  the 
expectant  mother  becoming  conscious  of  the  uterine  con- 
tractions through  dragging  pains  which  are  felt  first  in 
the  small  of  the  back  and  then  in  the  lower  part  of  the  abdo- 
men and  thighs.  In  the  beginning  the  pains  are  feeble  and 
infrequent,  but  they  gradually  grow  more  severe  and  more 
frequent.  Sometimes  the  first  sign  of  labor  is  a  gush  of 
fluid,  caused  by  the  rupture  of  the  membranes,  or  the 
appearance  of  blood,  but  these  are  not  typical.  Intestinal 
colic  is  sometimes  mistaken  for  labor  pains  by  women 
who  are  pregnant  for  the  first  time,  but  when  the  cramps 
come  regularly  and  the  uterus  is  felt,  through  the  abdom- 
inal wall,  to  grow  hard  as  the  pain  increases,  and  soft  as 
it  subsides,  there  can  be  no  doubt  that  they  are  labor  pains. 

This  is  the  time,  usually,  when  you  will  go  to  the  hos- 
pital, if  your  baby  is  to  be  born  there,  or  when  you  will 
notify  your  doctor  that  you  think  you  are  in  labor.  If  you 
are  to  remain  at  home  the  doctor  may  want  you  to  send  for 
the  nurse  at  once,  in  which  case  he  depends  upon  her  to 
communicate  with  him.  Or  he  may  prefer  that  you  notify 
him  and  let  him  send  the  nurse.  Either  arrangement  is 
simple  and  easy  to  carry  out,  but  you  must  be  sure  that 


102        GETTING  READY  TO  BE  A  MOTHER 

you  understand  just  what  the  doctor  wants  you  to  do  when 
you  think  Jabor  has  started  It  is  not  a  bad  plan  to  write 
down  his  instructions  about  this,  with  the  telephone  num- 
ber ^nd-  stxeet  .addt^s  pf  .the  .one  to  be  summoned,  so  that 
you  will  know  exactly  how,  t-Q  proceed  when  the  time  comes. 
The  entire  duration  of  labor  may  vary  from  a  few  mo- 
ments to  several  days,  but  the  average  length  of  the  first 
labor  is  about  eighteen  hours  and  of  subsequent  births 
about  tAvelve  hours.  The  process  is  usually  described  as 
being  divided  into  the  first,  second  and  tliird  stages  of  labor, 
approximately  as  follows : 

First  stage     Second  stage       Third  stage  Total 

First  labor        16  hours         1%  hours  15  minutes         18  hours 

Later  labors      11  hours         45  minutes         15  minutes         12  hours 

The  first  stage  begins  with  the  onset  of  labor  and  lasts 
until  the  cervical  canal  is  completely  dilated ;  the  second 
stage  begins  when  the  cervix  is  dilated  and  lasts  until  the 
baby  is  born ;  the  third  stage  begins  with  the  birth  of  the 
baby  and  lasts  until  the  afterbirth  is  expelled. 

First  Stage.  The  pains  are  mild  at  first  and  occur  at  in- 
tervals of  from  fifteen  to  thirty  minutes,  but  they  gradually 
increase  in  frequency  and  intensity  until  bj^  the  end  of 
fourteen  to  sixteen  hours,  they  are  very  severe,  and  recur 
every  three  or  four  minutes,  each  pain  lasting  about  one 
minute.  The  pains  begin  in  the  back,  then  pass  slowly  for- 
ward to  the  abdomen  and  down  into  the  thighs. 

The  average  woman  is  entirely  comfortable  between  pains 
and  until  they  become  very  frequent  she  will  usually  prefer 
to  be  up  and  about,  but  if  she  is  on  her  feet  when  a  con- 
traction begins  she  will  usually  seek  relief  by  leaning  for- 
ward on  something  secure,  as  the  foot  of  the  bed  or  a  table, 
or  by  sitting  down  until  the  pain  subsides.  As  time  passes, 
there  is  an  increasing,  sometimes  persistent  desire  to  empty 


THE  BABY'S  ARRIVAL  lO.J 

IIk'  bowels  and  bladder  because  of  pressure  upon  tliese  two 
or<i:ans  by  the  baby's  head  as  it  is  foreed  slowly  downward. 
There  may  be  vomiting,  also  when  the  cervix  becomes  nearly, 
or  quite  dilated. 

In  the  course  of  the  stretching  process,  the  cervix  sus- 
tains many  tiny  tears  from  which  blood  oo/.es  and  tinges  the 
vaginal  discharge.  Tiiis  bloodstained  discharge  is  often 
called  the  "show"  and  usually  appears  toward  the  end  of 
the  tirst  stage. 

When  the  cervix  is  fully  dilated,  the  menibianes,  or  bag 
of  w'aters,  usually  rujjture,  and  there  is  a  sudden  gush  of 
tiuid,  but  the  rupture  of  the  membranes  does  not  neces- 
sarily mark  the  end  of  the  first  stage.  Sometimes,  though 
not  often,  they  break  before  labor  begins,  thus  producing 
what  is  known  as  a  "dry"  labor.  They  may  rupture  before 
the  cervix  is  fully  dilated  or  they  may  not  rupture  at  all 
until  the  doctor  punctures  them  to  facilitate  the  baby's 
birth. 

If  the  nurse  is  delayed  in  reaching  you,  there  is  a  good 
deal  that  you  can  do  and  have  done,  during  this  first  stage 
of  labor,  in  the  way  of  preparing  for  the  baby's  arrival, 
this  preparation  relating  in  general  to  yourself  and  to  the 
room  including  placement  of  the  sterile  dressings. 

As  to  yourself,  try  first  to  picture  what  takes  place  during 
the  fifteen  or  sixteen  hours  of  the  first  stage.  The  baby's 
head  has  usually  passed  through  the  pelvic  inlet  and  not 
much  happens,  now,  beyond  the  widening  of  the  cervical 
canal,  as  the  bag  of  waters  is  forced  down  by  the  squeezing 
of  the  uterus  each  time  that  it  contracts.  (See  Fig.  23.) 
As  the  contractions  grow  stronger  and  more  frequent  you 
may  have  a  desire  to  help  matters  by  "bearing  down,"  or 
straining,  but  this  is  very  unwdse  for  nothing  that  3'ou  can 
do  will  hasten  the  dilation  of  the  cervix.  The  bearing  down 
will  tire  you  and  then  you  will  not  be  able  to  make  as  much 


104       GETTING  READY  TO  BE  A  MOTHER 

helpful  effort  during  the  second  stage  as  you  would  in  a 
fresh  and  rested  condition.  For  this  reason,  if  your  pains 
begin  at  night,  don't  get  up,  but  stay  in  bed  and  try  to 
get  as  much  sleep  as  possible.    If  they  begin  during  the  day, 


-    „  (      boTie 

txternaA  05       Vlaters 


Rect) 


urn. 


Fig.  23. — Drawing  showing  the  baby's  descent  at  the  time  of 
birth.  The  head  is  passing  through  the  inlet  and  pressure  by  the  bag 
of  waters  has  started  to  dilate  the  cervix.  (Drawn  by  Max  Brodel. 
Used  by  permission  of  A.  J.  Nystrom  and  Co.,  Chicago.) 


keep  up  and  about  during  most  of  the  time,  but  lie  down 
often  enough  and  long  enough  to  prevent  your  getting  tired. 
But  above  all  don't  bear  down  during  the  first  stage. 

Take  a  warm  soapsuds  enema ;  a  thorough,  warm,  sponge 
or  shower  bath,  scrubbing  the  inner  surface  of  the  thighs 
and  lower  abdomen  thoroughly,  but  do  not  bathe  between 


THE  BABY'S  ARRIVAL  105 

the  labia.  T*nt  on  a  froslily  lauiulci-cd  nigli1<^o\vii,  stock- 
ings, dressing-gown  and  slippers  and  braid  your  hair,  pref- 
erably in  two  braids. 

Drink  all  of  the  water  you  want  and  about  every  three 
or  four  hours  take  some  form  of  liquid  nourishment  such 
as  milk,  cocoa,  strained  soup  or  Iji-oth,  with  toast  or 
crackers.  Such  •nourishment  will  help  to  keep  you  from 
getting  tired  and  will  do  no  harm,  but  it  may  not  be  alto- 
gether wise  to  take  anything  more  solid  without  your  doc- 
tor's permission.  It  is  not  uncommon  for  one  to  feel  nause- 
ated toward  the  end  of  the  first  stage  and  this  tendency 
may  be  aggravated  by  taking  solid  food. 

One  thing  to  remember  is  the  very  great  importance  of 
your  poise  and  favorable  mental  attitude.  So  much  of 
proved  value  has  been  done,  and  still  is  being  done,  to 
safeguard  you  and  your  baby,  that  you  have  every  reason 
to  feel  calm  and  secure,  and  it  is  of  very  practical  im- 
portance that  you  cultivate  this  attitude.  The  woman  who 
allow^s  herself  to  become  excited,  nervous  and  apprehensive 
has  much  harder  time  than  the  one  who  asserts  her  self- 
mastery  and  preserves  a  tranquil  state  of  mind.  This  is 
so  definitely  the  case  that  for  the  sake  of  your  own  comfort 
I  cannot  urge  you  too  strongly  to  remember  it  and  to 
exclude  disturbing  or  exciting  infiuences  as  far  as  possible. 
One  of  the  most  troublesome  of  these  is  excitable  but  well- 
meaning  and  officious  friends  or  relatives.  Accordingly, 
if  your  nurse  is  not  at  hand  try  to  have  some  one  cool- 
headed  woman  with  you  and  insist  upon  excluding  those 
Avho  would  be  upsetting  or  likely  to  offer  advice  and  sug- 
gestions. In  getting  yourself  ready,  then,  it  is  advisable  to 
take  a  bath  and  an  enema ;  put  on  clean  clothing ;  not  to 
stay  in  bed  entirely  throughout  the  first  stage,  but  on  the 
other  hand  to  try  to  keep  mind  and  body  fresh  and  rested 
by  lying  down  when  you  begin  to  feel  tired,  taking  light 


106        GETTING  READY  TO  BE  A  MOTHER 

nourisliinent  regularly,  not  bearing  down  during-  pains  and 
denying  yourself  to  visitors  who  might  be  excitable. 

This  is  all  simple  enough  and  you  will  not  find  it  diffi- 
cult to  carry  it  out.  And,  happily,  the  preparations  relating 
to  the  room  are  equally  simple  and  uncomplicated. 

Either  you  or  the  friend  who  is  with  you,  may  make  the 
bed — you  if  you  feel  like  it,  she,  if  you- are  tired.  The 
mattress  is  covered  with  the  larger  of  the  two  pieces  of 
rubber  sheeting  that  you  have  in  readiness  and  over  this  is 
placed  the  lower  sheet,  stretched  very  smooth  and  tight 
and  tucked  well  under  the  mattress  at  head,  foot  and  sides. 
If  the  sheet  is  not  very  large,  it  may  be  made  secure  by 
being  pinned  with  safety-pins  to  the  under  side  of  the 
mattress.  The  smaller  rubber  is  then  placed  across  the 
middle  third  of  the  bed  and  over  this  a  muslin  sheet,  folded 
once  through  the  middle,  tucked  well  under  the  sides  of 
the  mattress.  Next,  the  upper  sheet,  a  light  blanket  and  a 
thin  counterpane,  all  left  open  at  the  foot,  and  a  pillow. 

The  packages  of  sterile  dressings,  douche  pan,  fountain 
syringe,  pitchers  and  basins  may  be  placed  on  the  tables, 
and  the  washstand  equipped  for  the  doctor's  hands  with 
soap,  sterile  nail-brush,  nail  scissors  and  file.  A  large 
kettle  or  pail  of  water  should  be  boiled,  covered  and  put 
aside  to  cool  and  a  large  receptacle  such  as  a  wash-boiler, 
half  or  two  thirds  full  of  water  put  on  to  boil  when  the 
pains  begin  to  come  about  every  five  minutes. 

The  baby's  bathtub  should  be  near  at  hand  for  sometimes 
babies  do  not  breathe  quite  satisfactorily  at  first  and  are 
helped  to  do  so  by  being  held  in  a  tub  of  warm  water. 
There  should  be,  also,  a  box,  basket  or  crib,  in  readiness  to 
receive  the  baby,  furnished  with  a  clean  blanket  and  hot- 
water  bottle  with  a  flannel  cover. 

These  are  the  preparations  which  may  be  made  during 
the  first  stage — that  period  when  the  cervix  is  being  slowly 


THE  BABY'S  AKHI\'AI.  107 

but  steadily  dilated  by  the  bag  of  waters  as  it  is  forced 
downward  b"  the  uterine  contraetions.  You  feel  these  as 
pains  beginning  in  the  back,  and  finally  in  the  lower  abdo- 
men and  thighd,  gradually  growing  stronger  and  more 
frequent. 

Second  Stage.  The  first  stage  is  ended,  and  the  second 
stage  begins,  when  the  eervix  is  wide  enough  for  the  baby 
to  pass  through.  From  this  time  on  you  should  stay  in  bed 
and  if  neither  the  doctor  nor  the  nurse  has  arrived,  your 
cool-headed  friend  must  stand  by  and  not  leave  you  alone. 
The  bag  of  waters  usually,  though  not  always,  breaks  at 
this  time,  and  there  is  a  rush  of  fluid.  But  the  character 
of  the  pains  changes  even  though  the  membranes  do  not 
rupture.  They  come  about  every  two  minutes,  now,  from 
the  beginning  of  one  pain  to  the  one  following,  each  pain 
lasting  about  a  minute.  They  are  stronger  and  more 
forcible  and  you  begin  to  have  an  uncontrollable  desire  to 
strain  or  bear  down. 

If  the  doctor  or  nurse  is  with  you,  they  will  tell  you  how 
to  use  your  pains  to  advantage,  but  if  tliey  are  not  there 
you  would  better  avoid  bearing  down  since  you  want  to 
retard  the  baby's  birth,  if  possible,  until  one  or  the  other 
arrives.  In  such  a  case,  you  may  delay  matters  by  opening 
your  mouth  and  breathing  deeply  during  pains  and  by 
lying  on  your  side. 

"We  all  know  that  in  spite  of  the  most  careful  planning, 
babies  are  sometimes  born  before  the  arrival  of  doctor  or 
nurse  and  that  the  mother  and  her  cool-headed  friend,  who 
is  standing  by,  meet  the  emergency  together.  Fortunately, 
births  occurring  under  such  circumstances  are  not  the  ones 
that  are  likely  to  be  associated  with  trouble  for  either  mother 
or  baby,  so  there  is  little  or  no  cause  for  concern.  ]\Iost 
doctors  feel  that  the  wisest  course  for  the  cool-headed  friend 
to  follow  at  such  a  time  is  to  do  nothing  at  all.     So  if  the 


108       GETTING  READY  TO  BE  A  MOTHER 

baby  arrives  in  advance  of  the  doctor,  why,  he  is  here,  and 
that  is  about  all  there  is  to  it !  The  moment  you  have  been 
longing  for,  for  nine  long  months,  has  come;  your  anxiety 
and  waiting  are  all  over,  and  with  much  less  trouble  than 
you  expected. 

Third  Stage.  After  the  baby  is  born,  your  pains  will 
subside  for  a  few  moments  and  then  the  uterus  will  begin 
again  to  contract  and  gradually  detach  the  placenta  from 
its  inner  surface,  forcing  it  out  just  as  the  baby  was 
expelled. 

In  the  meantime  the  baby  is  lying  on  the  foot  of  the  bed 
with  the  cord  connecting  him  with  the  placenta  which  is 
still  within  your  uterus.  Under  no  circumstances  should 
anyone  pull  on  the  cord  to  aid  in  the  expulsion  of  the  pla- 
centa. It  will  come  away,  naturally,  in  due  time.  When 
the  placenta  is  finally  expelled,  the  third  and  last  stage  of 
labor  is  over. 

In  case  you  and  your  cool-headed  friend  feel  that  some- 
thing should  be  done,  perhaps  I  would  better  assure  you 
once  more  that  when  a  baby  is  born  so  quickly  and  easily 
that  he  arrives  before  the  doctor,  you  have  cause  for  relief 
only — not  anxiety.  Practically  the  only  unfavorable  con- 
ditions which  may  arise  arc  liemorrliage  in  your  case  and 
failure  to  breathe  satisfactorily,  on  the  part  of  the  baby, 
and  you  and  your  cool-headed  friend  may  as  well  under- 
stand how  simply  these  possibilities  may  be  met. 

Although,  as  everj^one  knows,  there  is  normally  a  certain 
amount  of  blood  lost  at  the  time  of  confinement,  varying 
from  one  half  to  one  phit,  this  is  accepted  as  a  matter  of 
course.  A  serious  hemorrhage  very  rarely  occurs  because 
of  one  of  Nature's  ingenious  provisions.  The  tiny  muscle 
fibers  that  make  up  the  uterine  wall  run  in  every  direction, 
criss-cross,  up  and  down  and  around,  forming  a  veritable 
tangle.    After  the  placenta  comes  away,  all  of  these  little 


THE  BABY'S  ARRIVAL  109 

fibers  contract,  or  grow  shorter,  and  the  result  is  that  the 
muscles  squeeze  down  upon  the  blood-vessels  so  tightly 
that  they  are  closed  and  blood  cannot  escape. 

Accordingly,  as  long  as  the  uterine  muscles  are  contracted 
there  can  bo  no  hemorrhage.  The  fortunate  thing  about 
this  is  that  you  can  find  out  if  they  are  contracted,  and  if 
they  arc  not,  you,  yourself  can  stimulate  them  to  do  so. 
If  you  will  press  your  fingers  down  deep  into  your  abdomen, 
near  the  navel,  you  will  feel  the  uterus  as  a  hard  round 
mass,  which  is  often  likened  to  a  baseball.  If  it  continues 
to  feel  hard  and  round  there  cannot  be  any  serious  amount 
of  bleeding,  but  if  it  becomes  soft,  the  tiny  muscle  fibers  are 
relaxing  their  grip  on  the  vessels  and  bleeding  may  pos- 
sibly occur.  Quite  natui-ally  the  thing  to  do,  then,  is  to 
stimulate  the  muscles  to  contract  and  this  is  done  by  knead- 
ing the  uterus  through  the  abdominal  wall.  You  will  feel 
it  grow  hard  under  your  hand  and  then  you  will  know  that 
everything  is  all  right. 

Your  friend  may  want  to  bathe  you  and  put  on  a  pad 
but  it  would  be  better  to  leave  this  for  the  doctor  or  nurse 
for  this  reason  :  Childbed  fever  is  the  result  of  introducing 
infective  material  into  the  vagina.  Remember  that.  If  no 
germs  gain  entrance,  there  will  be  no  childbed  fever.  When 
your  baby  came  quickly  and  there  was  a  rush  of  water, 
your  vagina  was  well  washed  out.  If  you  and  your  friend 
keep  fingers  and  everything  else  away  from  the  vaginal 
outlet  and  the  area  immediately  surrounding  it,  it  will  re- 
main clean  and  you  need  not  worry  about  the  possibility  of 
infection. 

Perhaps  I  have  given  more  space  to  all  of  this  than 
seems  warrantable,  but  I  want  you  to  know  just  what  is 
going  on  so  that  you  will  not  be  worried.  And  also,  in  order 
that  you  will  not  make  trouble  for  yourself  by  trying  to 
do  something  when  all  that  you  really  need  do  is  to  lie  still, 


110       GETTING  READY  TO  BE  A  MOTHER 

as  comfortably  as  possible,  keep  your  hand  on  the  uterus 
and  knead  it  enough  to  keep  it  hard. 

If  your  friend  can  slip  out  the  wet  sheet  and  put  a  dry 
one  in  its  place,  without  your  having  to  turn  over,  you  will 
be  just  that  much  more  comfortable,  but  the  doctor  wall 
attend  to  everything  else  when  he  comes. 

Next  the  baby.  Presumably  he  is  lying  there  on  the  foot 
of  the  bed,  all  safe  and  sound,  trying  to  get  used  to  the 
new  order  of  things.  He  is  probably  making  his  presence 
known  by  crying  lustily  and  though  the  day  may  come 
when  that  sound  will  not  be  altogether  pleasant,  it  is 
nothing  short  of  music  to  you  now,  for  you  have  been  wait- 
ing a  long  time  to  hear  it.  The  baby  has  come  from  a  very 
warm  place  and  has  suddenly  undergone  the  most  abrupt 
change  in  his  entire  mode  of  living  that  he  will  ever  experi- 
ence, so  the  transition  should  be  made  as  easy  for  him  as 
possible.  There  are  two  things  which  he  must  do  immedi- 
ately, that  your  body  has  been  doing  for  him.  He  must 
breathe  through  his  lungs  and  he  must  keep  his  body  warm. 
If  he  has  cried  loudly,  your  faithful  cool-headed  friend  may 
just  wrap  a  little  blanket  about  him.  letting  him  lie  as  he 
is  until  the  doctor  comes,  taking  care  that  his  face  is  not 
covered  for  he  needs  plenty  of  air.  If  the  room  is  chilly 
she  might  place  a  flannel  covered  bag  of  warm  water  beside 
him  outside  the  blanket. 

If  the  baby  has  not  really  cried  lustily,  as  we  know  that 
even  the  youngest  baby  can,  he  should  be  made  to  cry,  as 
that  is  the  way  he  gets  his  breathing  apparatus  to  running 
as  it  should.  Your  friend  may  take  one  of  the  clean  little 
gauze  squares  that  you  prepared,  and  wrapping  it  around 
her  little  finger  reach  well  back  into  the  baby's  mouth  and 
remove  any  mucus  that  may  be  lodged  there  and  interfere 
with  his  breathing.  She  will  do  this  more  easily  and  thor- 
oughly if  she  will  pick  the  baby  up  by  the  feet,  with  one 


THE  BABY'S  ARRIVAL 


111 


finger  between  his  sliijpci-y  lit) If  aiikli's  so  that  her  grii)  will 
be  firm,  and  wipe  out  his  mouth  as  he  hangs  head  down. 
The  main  thing  to  remember  is  that  the  lining  of  that 


Fig.  24. — Tlelpinj;  the  lu-w  baby  to  brenthe  by  lioldinjj  him  head 
downward  and  sharply  spanking  him.  Note  that  the  nurse  has  one 
finger  between  the  baby 's  ankles  to  prevent  his  slipping  from  her 
haad. 


new  little  mouth  is  as  delicate  as  a  rose  leaf  and  if  it  is 
wiped  with  other  than  the  gentlest  stroke  the  surface  may 
be  injured  and  give  trouble  later  on.    While  he  is  hanging, 


112       GETTING  READY  TO  BE  A  MOTHER 

head  down,  your  friend  may  rub  his  back  or  stroke  it  with 
her  free  hand  and  in  all  probability  you  will  then  hear  the 
baby  use  his  lungs  to  your  heart's  content.  But  if  he  still 
does  not  cry  well  he  may  be  sharply  spanked  two  or  three 
times  as  shown  in  Fig.  24.  In  this  picture  the  cord  has  been 
cut  and  the  baby  is  removed  from  the  bed,  but  that  is  not 
necessary  for  it  is  very  common  to  hold  the  baby  up,  wipe 
out  his  mouth,  stroke  his  back  or  spank  him,  before  the  cord 
is  cut. 

You  need  not  be  at  all  disturbed  if  your  baby  needs 
these  little  forms  of  encouragement,  at  first,  for  remember 
that  all  of  a  sudden  he  is  given  some  very  complicated  and 
taxing  work  to  do  and  it  is  only  reasonable  that  he  should 
have  all  possible  help  as  he  undertakes  it. 

Remember,  too,  in  looking  forward  to  this  event,  that  the 
probability  that  you  or  your  friend  will  have  to  think  of 
any  of  these  things  is  very  remote  for  the  doctor  and  nurse 
are  almost  certain  to  be  with  you,  and  you  will  be  able  to 
give  yourself  over  entirely  to  being  very  happy  that  at 
last  your  baby  has  come. 


THE  IMTRACLE^ 

Elizabeth  Newport  Hephurn 

Tlie  wind  blows  down  the  street, 

A  shutter  ban<is  somewhere, 
Wliile  twilight  I'all.s  as  softly  as 

A  woman's  flowing  hair. 

Within  a  quiet  room, 

Adventurers  at  rest, 
A  mother  holds  her  new-born  son, 

Safe,  now,  ui)on  her  breast.' 

For  out  of  Night  and  Pain, 

The  womb  of  mystery, 
Is  sprung  this  miracle  of  Life 

That  she  can  touch  and  see. 

No  seer's  prophetic  dream. 

No  star  in  all  the  skies 
Burns  with  a  luster  half  so  bright 

As  happy  mother  eyes. 

No  questor  for  the  Grail, 

No  searcher  for  the  Truth, 
Counts  more  than  those  who  bear  and  r«ar 

And  love  and  nurture  Youth ! 

Within  her  cuning  arm. 

All  safe  and  warm  he  lies. 
The  heir  of  all  that  Man  has  won 

Down  countless  centuries ! 

Written  expressly  for  "Obstetrical  Nursing'^  by  Carohii  Conan' 
Van  Blarconi. 

113 


CHAPTER  VIII 
THE  BABY'S  MOTHER 

For  the  first  week  or  two  after  the  bab}^  comes,  you  will 
be  in  bed,  of  course ;  your  doctor  will  come  in  often  and 
you  will  doubtless  be  cared  for  by  a  nurse  devoted  ex- 
clusively to  you,  or  by  a  visiting  nurse  aided  by  members 
of  your  family.  You  will  find  that  it  is  money  well  spent 
to  keep  the  nurse,  or  someone  else,  to  care  for  and  help  you, 
for  six  or  eight  weeks  after  the  baby's  birth,  or  longer 
if  possible. 

Adequate  care  after  childbirth  accomplishes  two  im- 
portant ends.  It  practically  always  averts  such  immediate 
complications  as  hemorrhage  and  infection  and  it  prevents 
more  or  less  chronic  invalidism.  Infection  is  prevented  by 
the  scrupulously  clean  care  which  is  given  to  your  breasts 
and  perineum,  while  hemorrhage  is  avoided  by  keeping  you 
quiet  and  closely  watching  the  condition  of  the  uterus. 
Later  invalidism  is  prevented  by  the  many  precautions 
which  enter  into  your  general  care.  These  relate  to  your 
position  in  bed,  diet,  fresh  air,  rest,  exercise,  bathing,  atten- 
tion to  your  bowels;  observance  of  symptoms  and  conserv- 
ing all  of  your  forces  while  increasing  your  strength. 

All  of  these  details  are  important,  for  during  the  five  or 
six  weeks  after  confinement  certain  changes  take  place  in 
your  body  which  return  it  very  nearly  to  its  pre-pregnant 
state,  and  lack  of  watchful  care  while  these  changes  are  in 
progress  may  retard  them  and  result  in  your  being  more 
or  less  permanently  wretched. 

114 


TIIK  HAP.VS  MOTIIKK  11.-) 

Make  every  effort,  therefore,  to  secure  the  care  that  you 
need  during  this  transitional  period  of  five  or  six  weeks 
called  the  puerperium. 

You  will  doubtless  feel  a  little  tired  and  nervous  at  first, 
for  you  have  been  through  sometliing  of  an  .ordeal,  but 
when  one  considers  the  great  things  that  your  body  has 
accomplished,  your  recovery  and  return  to  a  normal  condi- 
tion will  be  surprisingly  rapid.  During  the  first  few  days 
you  are  likely  to  have  little  or  no  appetite  but  be  very 
thirsty;  be  constipated;  perspire  freelj^  and  have  an  in- 
creased amount  of  urine,  which  you  may  have  difficulty  in 
passing;  but  these  conditions  are  only  temporary. 

In  the  beginning  you  Avill  probably  be  nursed  just  about 
as  anyone  would  be  after  a  slight  operation,  with  the 
addition  of  special  attention  to  your  breasts  and  perineum 
to  prevent  infection,  and  the  toning  up  of  abdominal 
muscles.  In  order  to  prevent  bleeding  and  hasten  your 
recovery  you  will  be  kept  very  quiet  for  a  day  or  two,  per- 
haps flat  on  your  back ;  you  may  not  be  alloAved  to  have  any 
visitors  and  your  diet,  at  first  consisting  of  liquids,  w'ill 
finally  be  made  up  of  light,  easily  digestible  but  nourishing 
food. 

About  the  sixth  or  eighth  day  you  will  probably  begin  to 
sit  up  in  bed  and  about  the  ninth  or  tenth  day  you  may 
be  allowed  to  sit  up  in  a  chair  for  a  little  while.  Some 
young  mothers  are  able  to  sit  up  for  an  hour  the  first  time, 
without  fatigue,  while  others  can  sit  up  for  only  a  few 
moments,  morning  and  afternoon,  on  the  first  day,  grad- 
ually lengthening  the  period  each  time  that  they  get  up. 
You  will  probably  be  able  to  sit  up  an  hour  or  so  longer 
on  each  successive  day  and  walk  a  few  steps  on  the  third 
or  fourth  day  after  getting  up. 

These  first  few  days  of  being  up  and  trying  to  walk  are 
often  tiring,  and  a  little  discouraging  in  consequence,  but 


116        GETTING  READY  TO  BE  A  MOTHER 

of  course  you  will  gain  steadily,  even  though  it  be  slowly, 
do  a  little  more  each  day  and  gradually  feel  more  and  more 
like  your  old  self. 

The  mother  who  has  stitches,  because  of  the  perineum 
having  been  torn  at  the  time  of  the  baby's  birth,  does  not 
usually  sit  up  in  bed  until  the  ninth  or  tenth  day,  when 
the  stitches  are  removed,  sitting  up  in  a  chair  for  an  hour, 
two  or  three  daj's  later.  In  connection  with  tears  it  may  be 
well  for  you  to  know  that  in  spite  of  the  most  skillful  and 
careful  efforts  to  prevent  them,  tears  of  some  degree  usually 
occur  when  the  first  baby  is  born  and  in  about  half  of  the 
confinements  that  follow. 

But  as  most  tears  are  very  slight  and  are  immediately 
repaired  they  have  little  or  no  effect  upon  one's  comfort 
or  general  health. 

It  is  ordinarily  considered  a  safe  precaution  to  avoid 
going  up  and  down  stairs  until  the  baby  is  about  four  weeks 
old  and  not  wholly  to  resume  normal  activities  within  six 
or  eight  weeks  after  his  birth.  A  pinkish  or  red  discharge 
or  backache,  after  the  mother  gets  up  are  regarded  as  indi- 
cations that  she  is  not  quite  ready  to  do  much  standing  or 
walking  and  that  she  still  needs  a  good  deal  of  rest. 

The  whole  cpiestion  of  the  time  for  sitting  up,  of  getting 
up  and  of  walking  about  varies  so  with  different  individuals, 
as  you  see,  thai  'Jt  is  not  possible  to  describe  a  definite 
routine,  for  some  women  recover  slowly  and  would  be 
injured  by  getting  up  and  about  at  a  period  which  would 
be  entirely  safe  and  normal  for  the  majority.  The  doctor 
has  to  decide  what  is  best  in  each  case. 

While  you  are  being  actually  nursed  as  a  bed  patient, 
especial  attention  is  given  to  the  bathing  of  the  perineum, 
as  has  been  stated  ;  the  care  of  the  breasts  and  restoring  tone 
to  your  abdominal  muscles,  so  we  may  well  have  a  word  of 
explanation  about  each  of  these  details. 


TIIK  BABY'S  MOTH  I<:  11  117 

The  Perineum.  The  nurse  will  hallir  the  area  hetwecn 
your  tiiiglis  very  carefully,  al  regular  intervals,  using 
pledgets  soaked  in  some  kind  of  antiseptic  solution,  and 
put  on  a  fresh  one  of  the  sterile  pads  that  you  made  and 
sterilized  some  weeks  back.  This  attention  is  partly  to  pro- 
mote your  comfort  and  partly  to  remove  any  infective 
material  that  may  be  present,  thus  preventing  fever.  After 
the  care  that  you  have  had  up  to  this  time,  it  will  scarcely 
be  possible  for  you  to  have  childbed  fever  if  all  infective 
material  is  kept  away  from  the  vaginal  outlet.  I  speak 
of  this  in  order  that  you  may  realize  how  important  it  is 
for  you  to  avoid  touching  these  parts  Avith  your  fingers, 
upon  which  there  are  almost  certain  to  be  germs.  There  is 
little  doubt  that  women  sometimes  seriously  infect  them- 
selves after  the  doctor  and  nurse  have  taken  the  most 
scrupulous  care  to  protect  them  from  this  very  complication. 

Your  breasts  will  be  given  painstaking  care  in  order  that 
the  baby  may  nurse  satisfactorily  and  to  prevent  both  sore 
nipples  and  breast  abscesses.  If  you  cared  for  your  breasts 
during  the  latter  part  of  pregnancy  as  was  advised  in 
Chapter  V  and  will  continue  to  observe  ordinary  precau- 
tions while  the  baby  is  nursing,  it  is  not  at  all  likely  that 
you  will  have  any  trouble  with  your  breasts. 

The  main  features  of  the  care  of  your  breasts,  now,  are 
keeping  the  nipjiles  clean  and  supporting  the  breasts  them- 
selves if  they  grow  heavy  enough  to  be  uncomfortable.  This 
latter  condition  is  not  uncommon  about  the  third  or  fourth 
day  after  the  baby  is  born,  when  the  colostrum  is  replaced 
by  what  one  might  call  almost  a  rush  of  milk.  The  breasts 
may  then  become  hard,  swollen  and  uncomfortable  and 
sometimes  a  sensitive  lump  or  "cake"  may  be  felt.  The 
usual  course,  nowadays  is  simply  to  support  those  swollen 
breasts  and  to  apply  ice  bags  or  hot  compresses  to  the 
painful  areas. 


118        GETTING  READY  TO  BE  A  MOTHER 

There  are  innumerable  bandages  and  methods  for  sup- 
porting heavy  breasts,  any  one  of  which  is  satisfactory  so 
long  as  it  meets  the  two  chief  requirements :  to  lift  the 
breasts,  suspending  their  weight  from  the  shoulders,  and, 
while  fitting  snugly  below,  to  avoid  making  pressure  at  any 


Pig.  25. — Straight  binder  for  supporting  heavy  breasts,  or  holding 
lee  caps  in  place  on  breasts  that  are  painful.  Darts  are  pinned  in 
below  the  breasts  and  the  binder  is  lield  up  by  shoulder  straps,  pinned 
on  front  and  back. 

point,  particularly  over  the  nipples.  One  may  take  a  towel 
for  example,  or  a  straight  strip  of  muslin,  fasten  it  around 
the  chest,  pin  in  darts  below  the  breasts  with  safety-pins, 
and  provide  support  by  means  of  shoulder  straps,  attached 
with  safety-pins  to  the  front  and  back  of  the  binder.  Fig. 
25  shows  such  a  binder  being  used  to  hold  ice  bags  in  place, 
for  which  also  it  is  satisfactory  and  verv  easily  devised. 


Fig.  26. — Supporting  heavy  breasts  by  means  of  three  folded 
towels ;  one  fastened  about  the  waist,  one  over  each  shoulder,  cross- 
ing front  and  back. 


119 


120       GETTING  READY  TO  BE  A  MOTHER 

Three  folded  towels  or  folded  bands  of  muslin  will  pro- 
vide a  comfortable  support  if  applied  in  the  sling-like  man- 
ner indicated  in  Fig.  26 ;  the  Indian  binder  shown  in  Fig. 
27,  made  of  cheesecloth  or  any  soft  material  is  cool,  light 
and  very  comfortable,  and  in  addition  to  these  improvised 
binders  there  are  several  entirely  satisfactory  brassieres, 
opening  down  the  front,  to  be  bought  in  the  shops.  Happily 
the  discomfort  from  swollen  breasts  lasts  only  a  day  or 
two,  for  in  some  mysterious  way  Nature  makes  an  adjust- 


FiG.  27. — Indian  binder  for  supporting  heavy  breasts,  used  at  The 
Montreal  Maternity  Hospital.  The  tapering  ends  tie  in  a  knot  in 
front. 

meut  between  the  amount  of  milk  produced  by  the  mother 
and  that  withdrawn  by  the  baby.  So  as  he  comes  to  nurse 
regularly  and  satisfactorily,  the  excessive  supply  of  milk 
disappears,  and  with  it  the  discomfort. 

The  care  of  the  nipples  practically  resolves  itself  into 
keeping  them  clean  in  order  to  avoid  infection.  Notice 
that  I  say  keeping  them  clean,  for  merely  bathing  them, 
no  matter  how  regularly,  is  not  enough.  The  nurse  will 
probably  bathe  your  nipples  with  boracic  acid  solution  and 
sterile  cotton  pledgets  before  and  after  each  time  that  the 
baby  nurses,  and  keep  them  covered,  during  the  intervals, 
with  sterile  gauze  or  cotton. 

Here  again  you  may  undo  all  of  the  nurse's  careful  pre- 
cautions against  infection,  which  might  cause  an  abscess, 


THE  BABY'S  MOTHER 


121 


if  yon  touch  your  nipples  with  your  fingers  or  anything 
else  that  is  not  sterile,  exeei)t  the  bal)y's  moutli.  The  gauze 
squares  or  sponges  or  the 
cotton  pledgets  that  you 
sterilized  will  serve  excel- 
lently to  protect  your 
nipples  between  nursings. 
These  may  be  held  in  place 
by  a  binder  or  by  tapes 
tied  through  the  ends  of 
narrow  strips  of  adhesive 
plaster,  four  being  applied 
to  each  breast  as  shown  in 
Fig.  28.  Strips  of  adhesive 
plaster  about  five  inches 
long  are  folded  back  at  one 
end  so  that  two  adhesive 
surfaces  stick  together  for 
about  an  inch.  Through  a 
hole  cut  in  this  folded  end 
a  narrow  tape  or  bobbin  is 
tied,  and  the  strips  are 
applied  to  the  breast,  be- 
ginning at  the  margin  of 
the  darkened  area  and 
extending  outward.  The 
free  ends  of  the  tapes  are 
tied  over  pads  of  gauze  or 
cotton  between  nursings, 
and  untied  to  expose  the 
nipple  at  nursing  time. 

Lead  shields  are  sometimes  used  to  protect  the  nipples, 
being  held  in  place  by  means  of  a  binder.  These  shields 
should  be  scoured  and  boiled  dailv. 


Fig.     28. — Sterile    gauze    held    in 

place  over  nipples  by  means  of 

tapes  and  adhesive  strips. 


122        GETTING  READY  TO  BE  A  MOTHER 

Method  of  Nursing.  One  important  reason  for  all  of 
this  scrupulous  care  is  that  it  favors  the  baby's  nursing 
satisfactorily  and  without  interruption,  so  now  you  will 
want  to  know  about  the  actual  details  of  nursing  him. 

The  baby  is  usually  put  to  the  breast  for  the  first  time, 
between  eight  and  twelve  hours  after  he  is  born.  This  gives 
the  mother  an  opportunity  to  rest,  and  the  baby  too  profits 
by  being  quiet  and  undisturbed  during  this  interval.  His 
need  for  food  is  not  great  as  yet,  nor  is  there  mut^i  if  any 
nourishment  available  for  him.  There  is  no  hard  and  fast 
rule  for  the  mother's  position  in  bed,  while  nursing  her 
baby,  beyond  the  fact  that  both  she  and  the  infant  should 
be  in  a  relation  that  makes  the  nursing  easy.  One  very 
natural  and  satisfactory  method  is  for  her  to  turn  slightly 
to  one  side,  and  hold  the  baby  in  the  curve  of  her  arm  so 
that  he  may  easily  "grasp  the  nipple  on  that  side.  If  you 
take  this  position  you  should  hold  your  breast  from  the 
baby's  face  with  your  free  hand  by  placing  the  thumb 
above  and  the  fingers  below  the  nipple,  thus  leaving  his 
nose  uncovered  to  permit  free  breathing,  as  shown  in  Fig. 
29.  You  and  the  baby  should  lie  in  such  positions  that 
both  will  be  comfortable  and  relaxed  and  the  baby  will  be 
able  to  take  into  his  mouth,  not  only  the  nipple  but  much 
of  the  dark  circle  as  well,  so  as  to  compress  the  base  of  the 
nipple  with  his  jaws  and  extract  the  milk  by  suction. 

The  comfort  of  this  position  is  sometimes  increased  by 
laying  the  baby  on  a  small  pillow  placed  close  to  the 
mother's  side,  thus  raising  his  body  to  the  level  of  his 
head  as  it  rests  upon  her  arm. 

You  and  the  nurse  may  have  to  resort  to  a  number  of 
expedients  in  persuading  the  baby  to  begin  to  nurse,  for 
he  does  not  always  take  the  breast  eagerly  at  first.  He  must 
be  kept  awake,  first  and  foremost,  and  sometimes  suckling 
will  be  encouraged  by  patting  or  .stroking  liis  cheek  or  chin 


THE  P.AP.V'S  M0TIT?:R 


123 


or  lightly  spanking  his  buttocks.  If  his  head  is  drawn  away 
from  the  breast  a  little,  as  he  holds  the  nipple  in  his  mouth, 
he  will  sometimes  take  a  firmer  hold  and  begin  to  nurse. 
Moistening  the  nipple  by  expressing  a  few  drops  of  co- 


Fig. 


^9. — A  comfortable  j)osition  for  mother  and  baby,  while  nursing 
in  bed. 


lostrum   or  with   sweetened  Avater  may   whet  the  baby's 
appetite  and  thus  prompt  him  to  nurse. 

You  must  be  prepared  to  find  the  early  attempts  to  nurse 
your  baby  far  from  satisfactory,  but  if  you  persevere  in 


124       GETTING  READY  TO  BE  A  MOTHER 

making    attempts    regularly,    you    will    almost    certainly 
succeed. 

During  the  first  two  or  three  days  the  baby  obtains  only 
colostrum  while  nursing,  but  the  regular  suckling  is 
extremely  important,  not  alone  for  the  sake  of  getting  him 
into  the  habit  of  nursing  but  because  his  suckling  is  the 


Fig.  30. 


-Piotecting  cjacketl  or  sore  nipples  by  having  the  baby  nurse 
throusih  a  sliickl. 


best  and  surest  means  of  stimulating  your  breasts  to  pro- 
duce milk.  And,  as  we  shall  see  in  a  moment,  the  irritation 
of  the  nipples  in  this  manner  so  definitely  promotes  desir- 
able changes  in  the  uterus  that  these  go  on  more  rapidly 
in  women  who  nurse  their  babies  than  in  those  who  do  not. 
If  your  nipples  are  not  sufficiently  prominent  for  the 
baby  to  grasp  them,  or  if  they  become  sore,  you  may  have 
to  use  a  shield  for  a  while  as  shown  in  Figs.  30  and  31,  but 
the  shield  should  be  discarded  as  soon  as  possible  for  it  is 


TiiK  r.Aiivs  .M()tiii<:r 


12:) 


Fig.  31.— Xi])i.li' 
shield  used  in  Fig. 
30. 


the  baby's  suckling  that  produces  the  desired  effects.  If  a 
shield  is  used,  it  should  he  ^vashed  and  boiled  after  each 
nursing  and  kept  in  a  sterile  jar  or  solu- 
tion of  boracic  acid,  between  times. 

The  length  of  the  nursing  periods, 
and  the  intervals  between  them,  are  de- 
cided upon  hy  the  doctor  according  to 
the  needs  and  condition  of  each  baby: 
his  weight,  vigor,  the  rapidity  with 
v.iiich  he  nurses,  the  character  of  his 
stools  and  his  general  condition.  Tlie 
length  of  the  nursing  periods  them- 
selves, is  usually  from  ten  to  twenty 
minutes,  the  intervals  between  them 
being  measured  from  the  beginning  of 
one  feeding  to  the  beginning  of  the  next,  and  are  fairly 
uniform  for  babies  of  the  same  age  and  weight. 

The  average  baby  nurses  about  every  six  hours  during 
the  first  two  days,  or  four  times  in  twenty-four  hours. 
After  this,  according  to  one  schedule,  he  will  nurse  every 
three  hours  during  the  day  for  about  three  months  and  at 
10  p.  m.  and  2  a.  m.,  or  seven  times  in  twenty-four  hours. 
From  the  third  to  the  sixth  month  he  nurses  ever}'  three 
hours  during  the  day  and  at  ten  o'clock  at  night,  or  six 
times  in  twenty-four  hours,  and  from  that  time  until  he 
is  weaned  he  nurses  at  four-hour  intervals  during  the  day 
and  at  ten  o'clock  at  night,  or  five  times  daily.  Such  a 
feeding  schedule  may  be  arranged  in  a  table  as  follows : 


First  and  second  days 
First  three  months.  .  . 
Third  to  sixth  niontl'. . 
After  the  sixth  month 


Day 

Night 

(i..l2..   6 
6..   9.. 12. 
G..   9. .12. 
6.. 10..   2. 

.3..G 
.3..G 
.6 

12 

10..2a.m 
10. 
10. 

126       GETTING  READY  TO  BE  A  MOTHER 

It  is  becoming  more  and  more  common  to  omit  night  feed- 
ings after  ten  o  'clock  with  the  average  baby  who  is  in  good 
condition  even  during  the  first  three  months.  Wlien  this 
practice  is  adopted  the  baby  seems  not  only  to  do  as  well 
as  he  normally  should,  but  to  profit  by  the  long  digestive 
rest  during  the  night.  Certainly  the  mother  is  benefited  by 
the  unbroken  sleep  thus  made  possible. 

As  a  rule  the  baby  nurses  from  one  side,  only,  at  each 
nursing,  emptying  the  breasts  alternately,  but  if  there  is 
not  enough  milk  in  one  breast  for  a  complete  feeding  both 
breasts  may  be  used  at  one  nursing.  Neither  you  nor  the 
baby  should  go  to  sleep  while  he  is  at  the  breast,  but  he 
should  pause  every  four  or  five  minutes  to  keep  him  from 
feeding  too  rapidly. 

After  you  sit  up  you  will  find  it  a  good  plan  to  occupy 
a  low,  comfortable  chair  while  nursing  the  baby.  Lean 
slightly  iorward  and  raise  the  knee  upon  which  the  baby 
rests  by  placing  your  foot  on  a  stool ;  support  his  head  in 
the  curve  of  your  arm  and  hold  your  breast  from  his  face 
though  slightly  above  it,  just  as  you  did  while  nursing  him 
in  bed.  Nurse  him  in  a  quiet  room  where  you  will  not  be 
disturbed  and  where  neither  your  breasts  nor  the  baby 
will  be  exposed  to  drafts  or  the  possibility  of  being  chilled. 

Some  mothers  like  to  lie  down  while  nursing  the  baby, 
for  in  addition  to  finding  the  position  comfortable  they  are 
glad  to  have  these  regular,  though  short  periods  of  rest. 

Abdominal  Binders  and  Bed-Exercises.  Most  women 
are  interested  in  this  question  as  it  concerns  the  restora- 
tion or  preservation  of  the  "figure." 

The  application  of  a  snug  binder  for  the  first  day  or  two 
after  the  baby  comes,  is  a  fairly  common  practice,  for  many 
women  are  very  uncomfortable  as  a  result  of  the  sudden  re- 
lease of  tension  on  their  abdominal  Avails,  a  discomfort 
which  a  binder  relieves.     And  during  the  first  few  days 


TIIK  KABY'S  MOTHER  127 

after  the  mother  gets  up  and  walks  about  she  is  sometimes 
given  great  comfort  by  a  binder  that  is  put  on  and  snugly 
adjusted  about  her  hips  and  the  lower  part  of  her  abdomen, 
as  she  lies  on  her  back. 

In  addition  to  this,  some  doctors  like  to  have  the  young 
mother  wear  a  snug  binder  throughout  her  entire  stay  in 
bed,  while  others  instruct  their  patients  to  take  bed-exer- 
cises. If  the  binder  is  your  portion,  you  have  nothing 
to  do  but  wear  it,  for  some  one  else  must  put  it  on  you.  But 
if  bed-exercises  are  in  order,  the  following  descriptions  and 
pictures  of  the  exercises  taken  by  young  mothers  at  the 
Long  Island  College  Hospital  may  be  helpful. 

The  day  upon  which  the  exercises  are  started,  the  rate 
at  which  they  are  increased  and  the  length  of  time  during 
which  they  are  continued,  are,  of  course,  entirely  regulated 
by  the  doctor  according  to  the  strength  and  needs  of  each 
patient,  for  they  are  never  continued  to  the  point  of  fatigue. 
Quite  evidently,  then,  there  can  be  no  definite  directions 
for  these  exercises ;  one  can  give  only  a  description  of  the 
positions  and  movements  that  are  frequently  used  and  the 
order  in  which  they  are  adopted. 

The  average  mother  who  is  recovering  normally  begins 
the  chin-to-chest  exercise  from  twelve  to  twenty-four  hours 
after  the  baby 's  birth.  She  lies  flat  on  her  back  and  raises 
her  head  until  the  chin  rests  upon  her  chest.  (See  Fig.  32.) 
By  resting  her  hand  upon  the  abdomen  she  feels  for  her- 
self that  the  abdominal  muscles  contract  as  she  lifts  her 
head  and  accordingly  realizes  that  she  is  actually  exercising 
them.  The  movement  is  usually  repeated  twenty-five  times, 
morning  and  evening,  every  day  and  continued  as  long  as 
the  patient  is  in  bed. 

The  familiar  deep-breathing  exercise  comes  next  and  is 
ordinarily  started  on  the  third  or  fourth  day.  The  mother 
lies  flat,  Avith  her  arms  at  her  sides,  then  extends  them 


Fig.  32. 

Figs.  32  to  38  inclusive  are  bed  exercises  for  the  young  mother. 
For  description  see  text.  (From  photographs  taken  at  the  Long 
Island  College  Hospital.) 


Fig.  33. 


128 


TIIK  IJAIJV'S  MOTHER 


129 


straight  out  from  the  shoulders  (Fig.  33),  raises  them  above 
her  liead,  as  in  Fig.  34,  and  returns  thcni  to  their  original 


Fig.  34. 

position.     She  repeats  this  exercise  ten  times  morning  and 
evening  as  long  as  she  is  in  bed. 

The  one-leg  flexion  exercises  are  not  taken  bv  mothers  who 


Fig.  35. 


have  stitches,  but  in  other  cases  they  are  usually  started 
about  the  fifth  day.  One  thigh  is  flexed  sharply  on  the 
abdomen  and  the  foot  brought  down  to  the  buttocks  as  in 


130        GETTING  READY  TO  BE  A  MOTHER 

Fig,  35.  The  leg  is  then  straightened  out  and  lowered  to 
the  bed.  This  is  repeated  ten  times,  with  each  leg,  morn- 
ing and  evening,  for  two  or  three  days. 

The  next  exercise  sometimes  replaces  the  one-leg-flexion 


Fig.  36. 

and  sometimes  it  is  taken  up  in  addition  to  it,  being  started 
after  the  former  has  been  done  for  a  day  or  two,  according 
to  the  strength  of  the  mother.  Both  thighs  are  brought  up 
on  the  abdomen  in  this  one,  as  in  Fig.  36,  but  when  the 


Fig.  37. 


legs  are  straightened  the  feet  are  lowered  not  quite  to  the 
bed,  as  in  Fig.  37,  before  being  raised  again.  This  is  re- 
peated ten  times  morning  and  evening. 

Then  comes  the  exercise  for  which  the  leg-flexions  pre- 


TlIK  liABY'S  MOTHER 


^:n 


pare  the  mother  and  which  are  sometimes  discontinued 
when  this  one  is  adopted.  It  is  started,  as  a  rule,  about 
the  seventh  day,  or  two  or  three  days  before  the  mother  gets 
up.  Both  legs  are  slowly  raised  to  a  position  at  right 
angles  to  the  body,  as  in  Fig.  38,  and  slowly  lowered  but  not 
far  enough  for  the  heels  to  touch  the  bed  (see  Fig.  37),  and 
the  movement  repeated.     As  this  exercise  requires  a  good 


Fig.  38. 


deal  of  effort  it  is  taken  up  very  gradually,  somewhat  as 
follows :  The  legs  are  raised  once  in  the  morning  and  twice 
in  the  evening  of  the  first  day ;  second  day,  three  times  in 
the  morning  and  four  times  in  the  evening;  third  day, 
five  times  in  the  morning  and  six  times  in  the  evening  and 
so  on,  if  the  motlier  is  not  fatigued,  until  the  exercise  is 
repeated  ten  times  or  more  each  morning  and  evening  for 
several  months. 

The  knee-chest  position  shown  in  Fig.  39  is  intended 
to  prevent  a  misplacement  of  the  uterus,  from  which  so 
many  women  suffer  after  childbirth.  It  is  usually  started 
about  the  seventh  day  and  the  patient  begins  by  being 
assisted  to  that  position  and  keeping  it  for  a  moment  or 


132        GETTING  READY  TO  BE  A  MOTHER 

two,  gradually  lengthening  the  time  to  about  five  min- 
utes each  morning  and  evening ;  this  is  often  continued  for 
two  months  or  more. 

Walking  on  all  fours  is  violent  exercise  and  is  taken  up 
very  gradually.  Some  women  are  able  to  attempt  it  on 
the  first  day  out  of  bed,  if  they  have  been  taking  the  other 
exercises  regularly,  but  as  a  rule  it  is  not  started  until 
the  second,  third  or  fourth  day  after  getting  up.  The 
clothes  are  free  from  all  constrictions,  pajamas  being  very 
satisfactory;   the   knees   are   held   stiff  and   straight   with 


Fig.  39. — Kiiee  chest  position. 

the  feet  widely  separated,  to  allow  a  rush  of  air  into  the 
vagina,  and  the  entire  palmar  surface  of  the  hands  rests 
flat  on  the  floor.  (See  Fig.  40;)  The  patient  starts  by  tak- 
ing only  a  few  steps  each  morning  and  evening,  gradually 
lengthening  the  walk  to  five  minutes  twice  daily  and  con- 
tinuing it  for  about  two  months.  It  is  believed  that  as 
the  young  mother  walks  in  this  position  the  uterus  and 
rectum  rub  against  each  other,  producing  something  the 
same  result  as  would  be  obtained  if  it  were  possible  to 
massage  them,  the  effect  of  this  being  to  promote  involution, 
which  Avill  be  explained  later,  and  lessen  the  tendency 
toward  constipation  and  uterine  misplacement. 


THE  BABY'S  MOTHER 


133 


The  general  purpose  of  these  exercises,  as  a  whole,  then, 
is  to  strengthen  the  abdominal  muscles,  thus  helping  to  pre- 
vent a  large,  pendulous  abdomen ;  to  increase  the  con- 
valescing mother's  general  strength  and  tone  just  as  exer- 
cise benefits  the  average  person ;  to  promote  involution 
(See  page  134)  ;  to  prevent  misplacement  of  the  uterus  and 
in   u  mcasui'c  to   relieve  constipation.      In  order  that  the 


Fig.  40. — Walking  on  all  fours. 


exercises  may  accomplish  these  mueh-to-be-desired  ends, 
the  doctors  Avho  advise  them  feel  tliat  it  is  important  for 
them  to  be  taken  with  moderation  and  judgment ;  started 
slowly ;  increased  gradually  and  constantly  adjusted  to 
the  strengtli  of  the  individual  mother. 

Otherwise  they  may  do  more  harm  than  good. 

Concerning  the  changes  that  take  place  in  your  body 
during  the  puerperium,  the  ones  that  will  interest  you  par- 
ticularly are:  (1)  the  shrinkage  in  the  size  of  your  uterus 
and  its  gradual  descent  into  the  pelvis  where  it  was  before 


134       GETTING  READY  TO  BE  A  MOTHER 

the  baby  began  his  life  within  it;  (2)  the  production  of 
milk  by  your  breasts;  (3)  a  loss  of  body  weight. 

The  Uterus.  Immediately  after  delivery  the  uterus 
weighs  about  2  pounds;  is  from  7  to  8  inches  high;  about 
5  inches  across  and  4  inches  thick.  The  top  of  the  uterus, 
or  fundus,  may  be  felt  just  below  the  navel  and  the  inner 
surface  where  the  placenta  was  attached,  is  raw  and  bleed- 
ing. At  the  end  of  six  or  eight  weeks  the  organ  has  de- 
scended into  the  pelvic  cavity  and  resumed  approximately 
its  original  position  and  size  and  its  former  weight  of  2 
ounces.  This  return  of  the  uterus  to  practically  its  pre- 
pregnant  state  is  called  involution  and  in  the  interest  of 
3^our  immediate  recovery  and  future  health  it  is  important 
that  this  shall  progress  normally. 

There  is  evidently  a  close  relation  between  the  functions 
of  the  breasts  and  of  the  uterus  and  accordingly  involution 
is  likely  to  progress  more  satisfactorily  in  women  who  nurse 
their  babies  than  in  those  who  do  not.  The  so-called  "after- 
pains,"  also,  are  affected  by  nursing,  being  more  severe,  as 
a  rule,  when  the  baby  is  at  the  breast  than  at  other  times. 
These  pains  are  caused  by  alternate  contractions  and  relax- 
ations of  the  uterine  muscles  and  are  more  common  in 
women  who  have  had  other  children  than  after  the  first 
baby.  These  pains  usually  subside  after  the  first  twenty- 
four  hours,  though  they  may  persist  for  three  or  four  days. 

In  connection  with  the  changes  that  take  place  in  the 
uterus,  the  discharge  called  lochia  should  be  mentioned. 
This  is  qjiite  profuse  and  bloody  at  first  but  if  the  uterus 
involutes  normally  the  discharge  gradually  decreases  in 
amount  and  fades  in  color,  until  by  the  end  of  the  puer- 
perium  it  has  entirely  disappeared. 

The  Production  of  Milk.  During  the  first  two  or  three 
days  after  the  baby  is  born,  the  breasts  secrete  a  small 
amount  of  yellowish  fluid  called  colostrum,  which  differs 


Till-:   nAUVS  MOTHER  lU.-j 

somewhat  from  the  milk  that  eonies  later.  About  the  third 
day  the  meager  amount  of  colostrum  is  replaced  by  milk 
and  as  this  increases  i-apidiy  in  amount,  the  breasts  usually 
become  tense  and  swoUcn  and  sometimes  painful;  but  this 
discomfort  generally  subsides  in  a  day  or  two. 

The  production  of  milk  is  definitely  stimulated  by  the 
baby's  suckling  and  will  not  continue  for  more  than  a  few 
days  without  this  stimulation,  a  fact  to  be  remembered  if, 
for  any  reason,  it  is  desirable  to  dry  up  the  breasts.  The 
end  earnestly  to  be  desired  is  for  the  l^reasts  to  produce 
a  quantity  and  (luality  of  milk  which  will  adequately 
nourish  the  baby  during  the  hrst  eight  or  ten  months  of  his 
life,  and  with  proper  care  and  effort  this  ideal  can  nearly 
always  be  realized.  But  if  the  mother  becomes  pregnant 
while  nursing  her  baby — and  this  sometimes  occurs  as 
early  as  a  few  weeks  after  childbirth — the  quality  of  her 
milk  is  likely  to  suffer. 

The  return  of  menstruation,  however,  does  not  necessarily 
affect  the  milk  unfavorably,  as  is  so  generally  believed.  It 
is  true  that  in  the  ideal  course  of  events,  the  mother  does 
not  menstruate  while  nursing  her  baby,  that  is,  for  eight  or 
ten  months,  but  it  is  probable  that  about  one-third  of  all 
nursing  mothers  begin  to  menstruate  about  two  months 
after  confinement  and  half  of  those  who  do  not  nurse  their 
babies  begin  to  menstruate  in  six  weeks.  A  nursing 
mother  may  menstruate  once  and  then  not  again  for  sev- 
eral months  or  a  year ;  or  she  maj'  menstruate  regularly 
and  still  nurse  her  baby  satisfactorily. 

INIenstruation  is  more  likely  to  return  early  after  the 
birth  of  the  first  baby  than  after  those  born  subsequently. 
Mothers  sometimes  wonder  whether  this  early  discharge 
is  menstrual  oi-  lochial,  and  though  they,  themselves,  can- 
not possibly  distinguish  between  them,  a  physician  can 
easily  decide  by  examination,  and  in  the  interest  of  the 


136       GETTING  READY  TO  BE  A  MOTHER 

mother's  future  health  it  is  important  that  this  uncertainty 
be  cleared  up. 

The  loss  of  weight  is  one  of  the  striking  changes  which 
take  place  during  the  puerperium,  varying  in  different 
women  from  a  total  loss  of  from  twelve  to  fifteen  pounds. 
Fat  women  lose  more  than  thin  women  and  those  who 
nurse  their  babies  lose  more  than  those  who  do  not.  This 
loss  may  be  somewhat  controlled,  however,  by  suitable  diet 
and  under  most  conditions  the  mother  returns  to  not  less 
than  her  pre-pregnant  weight  by  the  end  of  the  sixth  or 
eighth  week.  You  will  recall  that  there  was  a  general  gain 
in  weight,  over  the  entire  body,  during  pregnancy,  in  addi- 
tion to  the  increased  weight  of  the  uterus. 

If  all  goes  well,  your  doctor  may  not  call  to  see  you  regu- 
larly after  the  first  couple  of  weeks,  but  he  will  probably 
want  to  make  a  thorough  examination,  sometime  about  five 
or  six  weeks  after  the  baby's  birth.  As  this  examination 
is  a  very  influential  factor  in  securing  your  future  health 
you  should  be  sure  to  have  it  made.  A  slight  abnormality, 
if  detected  at  this  time,  may  usually  l)e  corrected  with  little 
difficulty,  but  if  allowed  to  persist  may  result  in  chronic  in- 
validism, or  necessitate  an  operation.  In  case  the  uterus  is 
not  properly  involuted,  for  example,  or  the  perineum  is 
found  to  be  flabby,  a  little  more  rest  in  bed  is  indicated ; 
while  a  uterine  misplacement,  which  seems  to  occur  in  about 
a  third  of  all  cases,  usually  may  be  corrected  by  the  adjust- 
ment of  a  pessary.  Quite  evidently,  then,  it  rests  with  the 
young  mother  to  cooperate  with  the  doctor  in  guarding 
against  future  ill  health,  or  even  operations,  by  having  this 
final  examination  made  and  following  whatever  course  he 
prescribes,  as  a  result  of  his  inspection. 

Most  of  the  discussion  in  this  chapter  relates  to  the  care 
that  is  given  to  you  by  others,  in  preparing  you  to  take  up 
life  anew,  perhaps  unaided,  and  assume  the  care  of  your 


THE  BABY'S  MOTHER  137 

baby.  As  wo  shall  sec  in  tli<'  next  chapter,  the  care  of  your 
baby,  iur  the  next  IVw  months,  is  closely  associated  with  the 
care  which  you  take  of  yourself  and  the  regulation  of  your 
daily  life. 


CHAPTER  IX 

THE  MOTHER'S  CARE  OF  HERSELF— 
FOR  THE  BABY'S  SAKE 

Now  that  you  actually  have  your  baby  in  your  arms,  soft 
and  warm  and  lovely,  you  find  yourself  looking  into  those 
wide,  wondering  eyes  of  his  and  wanting  nothing  so  much 
as  to  give  him  your  protection. 

If  he  could  talk,  as  he  looks  back  at  you,  I  fancy  your 
baby  would  tell  you  how  much  your  care  of  him,  during 
the  months  before  he  was  born,  has  meant,  and  then  he 
would  beg  you  to  stand  by,  very  closely,  for  a  few  months 
more,  until  he  is  a  little  more  used  to  being  a  separate 
person  living  outside  your  body. 

"You  have  given  me  a  wonderful  start,"  he  seems  to  tell 
you,  "and  now  I  want  to  go  on  and  develop  the  best  pos- 
sible mind  and  body.  I  shall  be  able  to  do  this  if  you  will 
help  me,  for  what  you  can  give  me  now  is  of  more  impor- 
tance than  what  all  the  rest  of  the  people  in  the  world  can 
give.  You  can  give  me  through  your  milk  exactly  the 
materials  that  Nature  intends  me  to  use  to  develop  and 
build  this  partly  finished  body  of  mine,  and  to  protect  it 
from  disease.  Just  tide  me  over  this  most  difficult  period 
of  my  life,  and  I'll  be  a  credit  to  us  both,  not  only  as  a  baby 
but  as  a  growing  child  and  later  as  a  robust  man  or  woman, 
helping  to  do  my  share  of  the  world's  work.  I'll  have  fine 
straight  limbs  to  bear  me  on  my  way,  a  good  brain  to  help 
me  take  a  creditable  place  among  people  who  count,  and 
steady  nerves  I'll  have,  that  will  always  be  dependable. 

138 


THE  MOTHER'S  CARE  OP  HERSELF        139 

I'll  put  into  reality  the  dreams  that  you  and  I  are  dream- 
ing, and  when  I  do,  I  'II  look  back  to  these  early  weeks  and 
months  and  realize  that  I  eould  not  liave  done  it  but  for 
you." 

And  so  you  look  into  the  eyes  of  this  baby  of  yours  and 
pledge  yourself  to  stand  by  and  do  for  him  all  that  lies  in 
your  power,  realizing  already  that  the  keeping  of  that 
pledge  is  going  to  bring  you,  along  with  its  demands,  an 
endless  and  satisfying  hapi)iness;  a  consciousness  that  you 
are  doing  something  indispensable  to  youi-  baby's  welfare 
that  no  one  else  in  the  world  can  do. 

You  know,  now,  that  your  baby's  greatest  single  need 
for  the  next  few  months  is  satisfactory  nursing  at  your 
breast,  but  you  will  be  able  to  give  him  this  only  if  your 
diet  and  general  mode  of  living  are  favorable  to  the  produc- 
tion of  good  milk. 

Quite  evidently,  then,  your  big  service  to  your  baby,  for 
a  while,  is  largely  a  matter  of  caring  for  yourself. 

It  seldom  happens  that  the  mother  who  has  had  good 
prenatal  care,  followed  by  good  care  during  and  after 
labor,  is  unable  to  nurse  her  baby  if  she  orders  her  own 
life  in  the  way  that  is  known  to  be  necessary  to  promote 
and  maintain  the  production  of  breast  milk.  The  first 
essential  is  her  real  desire  to  nurse  her  baby,  next,  her 
appreciation  of  the  continuous  care  of  herself  that  is  neces- 
sary to  this  end,  and  third  her  whole-hearted  willingness 
to  take  such  care,  for  her  baby's  sake. 

It  is  safe  to  say  that  if  the  doctor  and  the  nurse  and  the 
baby's  mother  all  want  him  to  nurse  at  the  breast,  and  all 
do  everv'thing  in  their  power  to  make  this  possible,  they 
will  almost  invariably  succeed.  This  assertion  can  scarcely 
be  made  too  positively  and  we  should  never  lose  sight  of 
the  fact  that  if  the  baby  is  not  breast-fed  he  is  being 
defrauded,  and  in  the  vast  majority  of  cases,  because  of 


140       GETTING  READY  TO  BE  A  MOTHER 

insufficient  effort  on  the  part  of  those  who  are  caring  for 
him. 

Practically  the  only  conditions  which  doctors  in  general 
now  recognize  as  sufficient  reason  for  the  mother's  not 
nursing  her  baby  are  retracted  nipples,  tuberculosis,  con- 
vulsions, severe  heart  or  kidney  trouble,  certain  acute 
infectious  diseases  such  as  tj^phoid  fever,  and  the  state  of 
pregnancy. 

When  none  of  these  conditions  exist,  a  favorable  frame 
of  mind  and  a -state  of  good  nutrition  are  the  two  indispen- 
sable factors  in  establishing  breast-feeding  and  maintaining 
the  production  of  a  satisfactory  quantity  and  quality  of 
breast  milk.  These  factors  in  turn  are  both  affected  by  the 
mother's  general  mode  of  living. 

Women  with  happy,  cheerful  dispositions  usually  nurse 
their  babies  satisfactorily,  while  those  who  worry  and  fret 
are  likely  to  have  an  insufficient  supply  of  milk  or  milk 
of  a  poof  quality.  In  addition  to  this  sustained  intluence 
exerted  by  the  nursing  mother's  state  of  mind  it  is  well  to 
remember  that  the  quality  of  milk  that  has  been  entirely 
satisfactory  may  be  seriously  injured,  for  the  time  being, 
by  a  fit  of  temper,  fright,  grief,  anxiety  or  any  marked 
emotional  disturbance.  Actual  poisons  seem  to  be  created 
as  a  result  of  these  emotions  and  they  may  affect  the  baby 
so  unfavorabl}^  as  to  make  it  necessary  to  give  him  artificial 
food,  temporarily,  and  empty  the  breasts  by  pumping  or 
stripping  before  he  begins  to  nurse  again. 

I  realize  that  it  is  not  easy  entirely  to  reorganize  your 
life  and  assume  new  and  exacting  duties,  while  recovering 
from  an  experience  resembling  an  illness  in  some  of  its 
effects,  and  still  remain  calm,  undiscouraged  and  iierpet- 
ually  cheerful.  But  each  tiny  victory  that  you  accomplish 
in  your  attempt  to  achieve  this  end  will  bring  such  satis- 
faction that  you  will  not  count  the  cost.     And  the  incom- 


THE  MOTHER'S  CAKE  OF  HERSELF        141 

parable,  ahvays  deepenino:  happiness  of  watching  your  very 
o\vn  baby  grow  lovelier  and  sturdier,  day  by  day,  because  of 
the  things  that  you,  and  no  one  else,  are  (h)ing,  will  make 
yon  deny,  even  to  yourself,  that  anything  you  do  is  hard. 
Particularly  will  this  be  true  if  you  repeatedly  remind 
yourself  that  the  satisfactorily  bi-east-fed  baby  is  much 
more  likely  to  live  through  the  difficult  first  year  than  is 
tlu^  bottle-fed  baby,  and  also  is  much  less  susceptible  to 
disease  and  infection. 

We  shall  consider,  for  a  moment,  the  more  important  de- 
tails of  the  routine  care  that  you  should  give  yourself,  for 
the  baby's  sake,  and  tiien  we  shall  be  ready  for  the  pleasant- 
est  task  of  all — the  actual  care  of  the  baby  himself. 

In  general  you  should  try  to  live  just  a  normal,  tranquil, 
unhurried  kind  of  life  that  is  unfailingly  regular  in  its 
daily  routine. 

Diet.  As  was  the  case  during  pregnancy,  the  question 
of  your  diet  is  an  important  one.  Throughout  the  entire 
nursing  period  j'our  food  should  be  such  that  it  will  nourish 
5'ou  and  also  aid  in  producing  milk  of  a  character  that  will 
meet  the  baby's  needs,  the  needs  of  a  growing,  developing 
body.  The  best  producer  of  such  milk  is  a  diet  consisting 
largely  of  milk,  eggs,  "leafy"  vegetables  and  fresh  fruit, 
all  taken  with  an  appetite  made  keen  by  constant  fresh  air. 
Bear  this  in  mind  and  it  will  keep  you  from  putting  your 
faith  in  so-called  milk-producing  foods  and  nostrums. 

Your  meals  may  well  be  made  up  from  the  groups  of 
foods  that  are  suitable  for  the  expectant  mother,  as  given 
in  Chapter  V.  At  this  time,  as  during  pregnancy,  you 
should  avoid  all  food  that  may  produce  any  form  of  indi- 
gestion, but  for  the  baby's  sake  now,  as  well  as  your  own. 
While  it  is  not  generally  believed  by  doctors  of  to-day,  that 
there  are  many,  if  any,  articles  of  diet  which  maj'  in  them- 
selves injure  the  mother's  milk,  it  is  generally  accepted  that 


142       GETTING  READY  TO  BE  A  MOTHER 

if  her  digestion  is  upset  this  may  be,  and  usually  is,  bad 
for  her  milk  and  therefore  bad  for  the  baby. 

Certain  drugs  are  excreted  through  the  milk  and  may 
affect  the  baby  just  as  they  would  if  administered  to  him 
directly,  as  for  example  alcohol  and  opium,  from  which 
morphine,  heroin,  codein,  laudanum  and  paregoric  are 
derived. 

Although  the  old  belief  no  longer  holds  sway,  that  certain 
substances  from  such  highly  flavored  vegetables  as  onions, 
cabbages,  turnips  and  garlic  were  excreted  through  the 
milk  and  upset  the  baby,  it  is  definitely  known  that  cer- 
tain substances  in  certain  foods  are  excreted  through  the 
milk  to  the  baby's  great  advantage.  It  is  necessary  to  the 
baby's  well-being,  therefore,  that  the  nursing  mother's  diet 
shall  include,  regularly,  those  articles  of  food  which  contain 
these  substances.  These  foods  are  milk,  egg-yolk,  glandular 
organs  such  as  sweetbreads,  kidneys  and  liver ;  the  green 
salads  such  as  lettuce,  romaine,  endive,  and  cress  and 
the  citrous  fruits  which  are  oranges,  lemons,  grapefruit 
and  limes. 

These  are  called  ''protective  foods"  because  they  protect 
the  body  against  certain  diseases  which  will  be  described  in 
the  chapter  on  Nutrition.  It  is  possible  for  a  baby  who 
nurses  at  the  breast  of  a  woman  whose  diet  is  poor  in  pro- 
tective foods,  to  be  so  incompletely  nourished  as  to  be  on 
the  border  line  of  one  of  these  diseases,  or  even  to  develop 
the  disease  itself. 

It  becomes  apparent,  therefore,  that  although  you  did 
uot  have  to  "eat  for  two"  before  the  baby  came,  you  have 
to  do  so  now  in  certain  very  important  respects.  For  this 
reason  it  may  be  advisable  for  you  to  increase  the  nourish- 
ment provided  by  your  three  regular  meals  by  taking  a 
glass  of  milk,  cocoa,  or  some  beverage  made  of  milk,  during 
the  morning  and  afternoon  and  before  retiring. 


THE  MOTHER'S  CARE  OF  HERSELF   143 

The  morning  and  afternoon  lunches  would  better  be 
taken  about  an  hour  and  a  half  after  breakfast  and 
luncheon,  respectively,  in  order  not  to  spoil  your  appetite 
for  the  meals  which  follow.  It  is  of  considerable  inii)ortance 
that  you  take  your  meals  with  clock-like  regularity  and 
enjoy  them,  as  enjoyment  promotes  digestion ;  but  at  the 
same  time  you  should  guard  against  overeating  for  fear 
of  causing  indigestion,  as  this,  you  know,  is  almost  sure  to 
upset  the  baby.  Rich  and  highly  seasoned  foods,  in  fact 
any  articles  of  food  or  drink  which  might  uiiset  you,  should 
be  avoided  for  the  same  reason.  Drink  water  freely  but 
do  not  take  alcohol  nor  strong  tea  or  coffee  without  your 
doctor's  permission. 

Summing  up  the  matter  of  j-our  diet,  we  find  that  you 
should  have  light,  nourishing,  easily  digestible  food,  consist- 
ing chiefly  of  cereals,  creamed  dishes,  creamed  soups,  eggs, 
meat  in  moderation,  salads  and  the  fresh  fruits  and  vege- 
tables that  ordinarily  agree  with  you.  "Slany  doctors  advise 
at  least  a  quart  of  milk  daily,  in  addition  to  that  which  is 
used  in  preparing  the  meals  and  an  abundance  of  water 
to  drink. 

Bowels.  Your  bowels  should  move  freely  and  regularly 
every  day,  but  you  should  not  take  cathartics,  or  even 
enemata  without  your  doctor's  order.  You  probably  will 
be  able  to  establish  the  habit  of  a  daily  movement  by  taking 
exercise,  eating  bulky  fruit  and  vegetables,  drinking  an 
abundance  of  water  and  regularly  attempting  to  empty 
your  bowels  at  the  same  time  every  day,  preferably  im- 
mediately after  breakfast. 

Rest  and  Exercise.  You  will  not  be  likely  to  thrive, 
nor  will  the  baby,  unless  you  have  adequate  rest  and  sleep 
and  take  daily  at  least  a  moderate  amount  of  exercise  in  the 
open  air.  You  need  eight  hours  sleep,  out  of  twenty-four, 
in  a  room  with  the  windows  open,  and  as  fatigue  is  bad 


144        GETTING  READY  TO  BE  A  MOTHER 

for  your  milk  it  may  be  a  good  plan  for  you  to  lie  down 
for  a  while  every  afternoon.  Your  exercise  will,  of  course, 
have  to  be  adjusted  to  your  tastes,  habits,  circumstances 
and  physical  endurance,  for  it  must  always  be  stopped 
before  you  are  tired.  Walking  is  often  the  best  form  of 
exercise  that  the  nursing  mother  can  take  and  though  as  a 
rule  she  may  engage  in  any  mild  sports  that  she  enjoys, 
violent  exercise  is  inadvisable  because  of  the  exhaustion  that 
may  follow. 

Recreation.  Part  of  the  value  of  exercise  lies  in  the 
pleasure  and  diversion  which  it  offers,  for  as  we  have  seen, 
a  happy,  contented  frame  of  mind  is  practically  indis- 
pensable to  the  production  of  good  milk.  In  addition  to 
some  regular  and  enjoyable  exercise,  therefore,  you  need  a 
certain  amount  of  recreation  and  change  of  thought  and 
environment.  If  life  is  monotonous  and  colorless,  the 
average  woman  is  almost  sure  to  become  irritable  and 
depressed ;  to  lose  her  poise  and  perspective ;  to  worry  and 
fret,  and  then,  no  matter  wiiat  she  eats  nor  how  much  she 
sleeps,  her  digestion  will  suffer,  her  milk  will  be  affected 
and  the  baby  will  pay.  This,  of  course,  goes  back  to  the 
question  of  the  young  mother's  mental  state  and  the  condi- 
tion of  her  nerves  as  determining  factors  in  her  ability  to 
nurse  the  baby  successfully. 

Just  here  it  is  important  to  say  a  word  of  caution  about 
this  very  question  of  your  attitude  of  mind,  particularly  as 
it  relates  to  your  care  of  yourself. 

It  may  be  that  one  of  the  most  difficult  tasks  you  will 
have  will  be  that  of  getting  out  of  tlie  habit  of  accepting 
the  position  that  borders  on  being  an  invalid — of  being  a 
protected  person  who  is  thought  about,  cared  for  and  con- 
sidered at  every  turn.  This  has  been  your  position  for 
several  months  and  the  most  natural  result  of  it  all  is  a 
tendency  to  cling,  perhaps  ever  so  little  and  even  uncon- 


THE  MOTHER'S  CAKE  OF  HERSELF        145 

sciously,  to  this  very  pleasant  state.  It  is  not  possible  for 
anyone  to  reduce  so  broad  and  intangible  a  subject  to 
a  few  definite  words  of  advice.  But  think  it  over  for  your- 
self and  try  to  strike  that  happiest  of  happy  mediums  that 
lies  somewhere  between  the  ecjually  harmful  courses  of 
coddling  j-ourself  and  of  overdoing. 

A  good  many  doctors  think  that  for  the  sake  of  giving 
the  nursing  mother  an  opportunity  to  go  out,  mingle  with 
her  friends,  take  in  some  music  or  a  play,  it  is  often  a 
good  plan  to  replace  one  breast  feeding,  sometime  in  the 
course  of  each  day,  with  a  bottle  feeding.  The  freedom 
which  this  long  interval  between  two  nursings  gives  the 
mother  for  diversion  and  amusement,  will  often  affect  her 
general  condition  so  favorably  that  the  ciuality  of  her  milk 
is  definitely  better  than  it  otherwise  would  be  and  the 
baby  is  benefited  as  a  result.  This  single  supplementary 
feeding  cannot  be  regarded  lightly,  however,  for  it  must  be 
prepared  with  the  same  cleanliness  and  accuracy  as  an 
entirely  artificial  diet,  which  will  be  described  in  the  next 
chapter. 

Weaning.  One  advantage  in  giving  the  baby  a  supple- 
mentary bottle  once  a  day,  is  that  it  paves  the  way  for 
weaning,  when  the  time  conies  to  make  this  change.  Under 
ordinary  conditions,  the  mother  begins  to  wean  her  baby 
about  the  eighth  or  tenth  month.  Having  started  by  re- 
placing one  breast  feeding,  daily,  Avith  a  bottle  feeding, 
she  gradually  increases  the  number  of  bottles  given  daily 
until  the  breast  feedings  are  discontinued  by  the  time  the 
baby  is  eleven  or  twelve  months  old.  There  are  exceptions 
to  this  general  rule,  of  course,  and  under  any  conditions  the 
weaning  should  always  be  directed  by  a  doctor,  for  the  baby 
may  suffer  seriously  unless  the  change  in  food  is  skillfully 
made.  If  the  mother's  milk  is  satisfactory  and  the  baby 
is  doing  well,  it  is  often  considered  wise  not  to  discontinue 


146        GETTING  READY  TO  BE  A  MOTHER 

the  breast  feeding  entirely,  during  the  hot  summer  months 
even  though  the  weaning  falls  due  at  this  time. 

It  was  formerly  deemed  advisable  to  wean  the  baby  for 
any  one  of  several  reasons,  but  at  present  the  only  indica- 
tions for  this  step  which  seem  to  be  generally  accepted  by 
the  medical  profession,  are :  pulmonary  tuberculosis,  acute 
infectious  diseases  in  the  mother  and  pregnancy.  ]\Ienstru- 
ation  was  long  regarded  as  incompatible  with  satisfactory 
nursing,  but  it  is  now  known  that  if  the  mother  is  taking 
proper  care  of  herself  and  is  in  generally  good  condition, 
the  impoverishing  effect  of  menstruation  upon  the  milk  is 
usually  for  the  duration  of  the  periods  only.  It  may  be 
necessary  to  supplement  the  breast  feeding  Avith  suitably 
modified  cows'  milk  during  menstruation,  but  the  baby 
should  be  put  to  the  breast  regularly,  just  the  same,  for  if 
the  stimulation  of  the  baby's  svickling  is  discontinued,  the 
temporary  reduction  in  the  amount  of  the  milk  secreted 
will  probably  become  permanent. 

The  state  of  pregnancy,  however,  is  different,  for  though 
some  women  nurse  a  baby  satisfactorily  for  some  months 
after  becoming  pregnant,  it  is  not  considered  advisable  to 
subject  any  woman  to  the  combined  strain  of  pregnancy 
and  nursing.  IMoreover,  the  mother's  milk  is  usually  so 
impoverished  during  pregnancy  that  the  nursing  baby 
suffers  in  consequence. 

Drying  up  the  breasts  used  to  be  a  great  bugbear. 
Lotions,  ointments  and  binders  were  employed  and  often  a 
breast  pump  as  well.  Various  drugs  were  given  by  mouth 
and  the  mother  was  more  or  less  rigidly  dieted.  It  is  true 
that  some  of  these  measures  are  still  employed  and  are 
followed  by  a  disappearance  of  the  milk.  But  at  the  same 
time,  the  breasts  dry  up  quite  as  satisfactorily^  when  none 
of  these  things  are  done,  provided  the  baby  does  not  nurse. 
It  is  not  known  what  starts  the  secretion  of  milk  in  the 


THE  MOTHER'S  CAKK  OF  HERSELF        147 

mother's  breasts,  but  certain  it  is  that  absence  of  the  baby's 
suckling  stops  it. 

If  it  is  left  to  you  to  dry  up  your  breasts,  your  safest 
course  will  be  to  do  nothing  beyond  applying  a  supporting 
bandage,  if  your  breasts  are  heavy  enough  to  be  uncom- 
fortable, and  keeping  your  nipples  scrupulously  clean.  You 
may  rely  absolutely  upon  the  fact  that  tlic  baby's  suckling 
is  the  most  important  stimulation  in  promoting  the  activity 
of  the  breasts  and  if  this  stimulation  is  not  given,  or  is 
removed,  the  secretion  of  milk  will  invariably  subside  in  the 
course  of  a  few  days.  This  is  true  whether  the  reason  for 
drying  up  the  breasts  is  that  the  baby  is  stillborn  or  has 
died,  or  a  live  baby's  nursing  is  discontinued.  It  is  true 
that  the  breasts  may  be  swollen  and  very  uncomfortable 
for  a  day  or  two,  and  in  addition  to  a  supporting  bandage 
the  doctor  may  order  sedatives,  but  the  discomfort  sub- 
sides as  the  milk  disappears. 

Quite  naturally  you  will  not  drink  an  extra  amount  of 
milk  if  j-ou  are  drying  up  your  breasts,  but  it  probably 
will  not  be  necessary  to  place  any  other  restrictions  upon 
5'our  diet. 

In  thinking  over  the  nursing  period  as  a  whole,  we  find 
that  after  all  it  is  a  fairly  simple  matter  so  to  order  one's 
life  as  to  promote  and  maintain  a  satisfactory  supply  of 
milk.  The  milk  thus  i)roduced  is  the  ideal  baby  food  and 
there  is  no  entirely  adequate  suhstitiite.  Never  forget  that. 
It  gives  the  baby  enormously  increased  chances  of  living 
past  babyhood  and  protects  him  from  many  diseases. 

Quite  evidently  breast  feeding  is  every  baby's  birthright 
and  his  mother  is  the  only  one  who  can  deprive  him  of  it. 


CHAPTER  X 

THE  MOTHER'S  CARE  OF  HER  BABY 

"The  mother  is  the  natural  guardian  of  her  child;  no  other 
influence  can  compare  with  hers  in  its  value  in  safeguarding 
infant  life." — Sir  Arthur  Newsholme. 

Before  undertaking  the  care  of  the  new  baby,  suppose 
we  stop  for  a  moment,  and  consider  just  what  he  repre- 
sents ;  what  he  has  been  through ;  what  struggles  and  dan- 
gers are  ahead  of  him ;  what  are  the  weaknesses  of  his 
equipment  to  meet  these  perils  and  what  must  be  the 
character  of  your  service  to  him  if  you  are  to  do  quite  all 
in  your  power  to  help  him  safely  over  this  hazardous  period 
of  early  infancy. 

At  the  time  of  birth,  the  baby  makes  the  most  complete 
and  abrupt  change  in  his  surroundings  and  condition  that 
he  will  make  during  his  entire  lifetime. 

•For  nine  months  he  has  existed  under  ideal  conditions; 
he  has  been  safeguarded  from  injury ;  kept  at  the  tempera- 
ture which  was  best  for  him,  and  above  all,  has  been 
furnished  with  exactly  the  proper  amount  and  character 
of  nourishment  necessary  for  his  growth  and  development. 
Suddenly  he  emerges  from  this  completely  protecting  en- 
vironment into  a  more  or  less  hostile  world,  where  he  must 
assume  the  task  of  living,  with  a  frail  little  body  that  in 
many  respects  is  only  imperfectly  developed.  And  yet  the 
baby  must  not  only  continue  the  bodily  functions  and 
activities  that  were  begun   during  his  intra-uterine  life, 

148 


THE  MOTHER'S  CARE  OF  IIi:i{   I'.AI'.V       140 

l)ut  must  develop  certain  functions  wliicii  were  imperfect 
anil  even  establish  others  which  were  performed  for  him. 

Vou  will  recall  that  while  within  the  uterus,  the  baby 
received  his  nourishment  and  oxygen  and  gave  up  waste 
material  through  the  placenta.  Accordingly,  his  organs  of 
digestion,  resjiiration  and  excretion  are  imperfe(;tly  de- 
veloped at  birth  and  are  capable  of  functioning  only  within 
very  narrow  limits  at  first. 

His  respirations  are  usually  established  inunediately  after 
birth,  when  he  cries  vigorously,  for  his  lungs  are  therel)y 
filled  with  air.  The  other  functions  are  established  more 
gradually  and  the  care  of  the  baby  must  be  such  that  the 
immature,  unused  organs  will  have  their  development  pro- 
moted through  activity  and  yet  not  be  overtaxed. 

The  Baby's  Condition  at  Birth.  The  newborn  baby  boy 
weighs  from  seven  and  a  (puirter  to  seven  and  a  half  pounds 
and  is  about  twenty  inches  long,  girl  babies  being  perhaps 
a  little  smaller.  His  body  is  well  rounded  and  his  flesh 
firm.  The  skin  is  a  deep  pink,  or  even  red,  and  is  covered 
with  the  cheesy  substance  called  vernix  caseosa,  which  is 
likely  to  be  thickly  deposited  over  the  back  and  in  folds  of 
the  skin  and  creases,  as  in  the  thighs  and  under  the  arms. 
Some  babies  still  have,  when  born,  the  tine  downy  hair  on 
parts  or  all  of  the  body,  that  they  had  before  birth. 

The  head  and  al)domen  are  relatively  large,  the  chest 
narrow  and  the  liml)s  short.  The  legs  are  so  markedly 
bowed  that  the  soles  of  the  baby's  feet  may  nearly  or  quite 
face  each  other,  but  they  finally  assume  a  normal  position. 
The  bones  are  still  soft  and  the  entire  body  is,  therefore, 
very  flexible.  Some  of  the  bones  which  unite  later  in  life 
and  make  the  adult  skeleton  firm  and  rigid,  are  separate  at 
birth. 

IMost  new'born  babies  have  faded  blue  eyes,  the  permanent 
color  appearing  gradually,  but  the  amount  and  color  of  the 


150       GETTING  READY  TO  BE  A  MOTHER 

hair  varies  greatly,  some  babies  being  bald,  while  others 
have  abundant  hair  from  the  beginning. 

The  shape  of  the  baby's  head  is  often  badly  distorted  at 
birth,  being  so  long  from  chin  to  crown  that  the  mother  is 
deeply  concerned.  But  you  may  rest  quite  assured  that 
even  though  badly  misshapen,  your  baby's  head  in  the 
course  of  a  few  days  will  assume  the  lovely,  rounded  con- 
tour so  characteristic  of  babyhood.  The  temporary  de- 
formity of  the  head  is  caused  by  a  molding  and  over- 
lapping of  the  bones  of  the  skull  as  it  is  forced  through  the 
narrow  part  of  the  pelvis,  the  inlet,  that  we  learned  about 
in  Chapter  III.  About  the  middle  of  the  top  of  the  head 
you  will  be  able  to  feel  a  soft,  diamond  shaped  spot  and 
farther  back  another  soft  spot,  smaller  than  the  one  in 
front  and  somewhat  triangular  in  its  outline.  These  soft 
places  are  openings  between  the  bones  of  the  skull  and  are 
called  the  anterior  and  posterior  fontanelles.  They  always 
may  be  felt  on  the  new  baby's  head. 

Growth  and  Development.  The  physical  progress  which 
is  made  during  the  first  year  by  average,  normal  babies  who 
are  satisfactorily  nourished  and  cared  for  is  fairly  uniform 
and  the  average  rate  of  this  progress  is  somewhat  as  follows : 

Weight.  There  is  a  loss  in  weight  of  6  to  10  ounces 
during  the  first  week  of  life,  after  which  the  baby  usually 
gains  from  4  to  8  ounces  each  week,  during  the  first  five 
months.  From  this  time  the  gain  is  only  about  half  as 
rapid,  or  at  the  rate  of  2  to  4  ounces  weekly.  At  six  months, 
therefore,  the  average  haby  weighs  from  15  to  16  pounds, 
or  double  the  normal  birth  weight  of  7i/o  pounds,  and  at 
twelve  months  he  weighs  from  20  to  22  pounds,  or  three 
times  the  average  birth  weight.  Fig.  41  gives  an  idea  of 
how  the  baby's  weight  drops  during  the  first  week  and  the 
rate  of  the  normal  weekly  gain  afterwards,  during  the 
first  year. 


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152        GETTING  READY  TO  BE  A  MOTHER 

The  weight  is  perhaps  the  most  valuable  single  index  to 
the  baby's  condition  that  we  have,  but  at  the  same  time 
it  must  be  rememhered  that^  baby  whose  food  contains  an 
excess  of  sugar  or  starch  may  be  of  normal  weight,  or  over, 
but  be  incompletely  nourished  and  very  susceptible  to 
infection,  while  other  babies  Avho  are  small  and  gain  slowly 
are  sometimes  very  well  and  vigorous.  Moreover,  cjuite 
commonly  there  are  periods  in  the  lives  of  entirely  normal 
babies  during  which  there  is  little  or  no  gain  in  weight. 
This  may  occur  during  the  period  from  the  seventh  to  the 
tenth  month,  for  example,  or  in  very  warm  weather.  But 
the  doctor  is  likely  to  want  to  Avatch  the  baby's  weight, 
for  when  studied  in  conjunction  with  other  conditions  it 
gives  a  certain  amount  of  information  about  the  baby's  gen- 
eral state  and  progress. 

Height.  The  height  of  the  average  baby  at  birth  is  about 
20  inches,  though  boys  may  measure  a  little  more  and  girls 
a  little  less ;  at  six  months  it  is  about  25  inches  and  28  or  29 
inches  at  the  end  of  a  year. 

Head  and  Chest.  The  circumferences  of  the  head  and 
chest  are  about  the  same  at  birth,  the  chest  being  possibly 
a  little  the  smaller  of  the  two.  Both  measure  about  13^2 
inches,  gradually  increasing  to  about  I6I/2  inches  in  six 
months  and  to  18  inches  by  the  end  of  the  first  year. 

Fontanelles.  The  posterior  fontanelle,  the  one  at  the 
crown  of  the  head,  usually  closes  in  six  or  eight  weeks 
but  the  larger,  anterior  fontanelle  is  not  entirely  closed 
until  the  baby  is  about  eighteen  or  twenty  months  old. 

Teeth.  Although  it  occasionally  happens  that  a  baby 
has  one  or  two  teeth  at  birth,  the  average  infant  has  none 
until  the  sixth  or  seventh  month,  when  the  two  lower,  cen- 
tral incisors  appear.  After  a  pause  of  a  few  Aveeks  the 
two  upper,  central  incisors  come  through,  followed  by  the 
two  lateral  incisors  in  the  upper  jaw.     At  the  end  of  the 


THE  MOTHER'S  CARE  OK   II KK  V.W.Y       15:5 


first  year,  therororc  tlic  Jivcraj^n'  I);ii)y  hns  six  tooth,  or  eight 
if  the  lower  lateral  incisors  have  appeared  ])y  the  first 
birthday,  as  they  sometimes  do.  This  is  the  visual  course 
of  dentition,  during  the  first  year,  as  shown  in  Fig.  42, 
lint  til  ere  are  wide  variations  among  entirely  well  and 
normal  babies,  the  first  tooth  sometimes  not  appearing  be- 
fore the  tenth,  eleventh  or  even  twelfth  month.    As  a  rule, 


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Fig.  42. — Diaoraiu   sluiwinu    first,  or  "milk,"  teeth  and  the  ages  at 
which  I  hoy  usually  appear. 

however,  an  entire  lack  of  teeth  by  the  time  the  baby  is  a 
year  old  is  regarded  as  an  evidence  of  faulty  nutrition. 

The  baby  w'ho  is  properly  fed  and  cared  for,  cuts  his 
teeth  with  little  or  no  trouble,  in  spite  of  the  widely  current 
but  seriously  mistaken  belief  that  a  teething  baby  is  a  sick 
baby.  AVe  have  no  way  of  estimating  the  number  of  babies 
who  die,  needlessly,  as  a  result  of  this  dangerous  convic- 
tion, for  if  the  baby  is  sick  while  teething,  the  trouble  is  all 
too  often  accepted  as  a  normal  occurrence  and  is  not  given 
the  attention  it  needs  until  too  late.  Frail,  delicate  babies 
may  have  convulsions  each  time  that  a  tooth  is  cut  and  if 
a  baby  is  having  digestive  trouble,  this  is  likely  to  grow 
worse  while  he  is  teetliing.     l>ut  cutting  teeth  is  a  normal 


154       GETTING  READY  TO  BE  A  MOTHER 

process  and  the  healthy,  properly  fed  baby  suffers  little  or 
no  inconvenience  while  it  is  in  progress. 

Stools  and  Urine.  During  the  first  two  or  three  days  the 
stools  are  of  dark  green,  tarry  material  called  meconium. 
In  the  course  of  two  or  three  days  they  begin  to  grow 
lighter  and  shortly  the  normal  stools  appear,  these  being 
bright  yellow  in  color,  of  a  smooth,  pasty  consistency  and 
having  a  characteristic  odor.     During  the  first  month  or 


Fig.  43. — Appearance  of  cord  immediately  after  birth. 

six  weeks  the  baby's  bowels  may  move  three  or  four  times 
daily,  but  after  this  they  usually  move  but  once  or  twice 
in  the  course  of  twenty-four  hours.  As  the  nourishment  is 
increased,  the  stools  grow  somewhat  darker  and  firmer  and 
finally  become  formed. 

The  newborn  baby's  bladder  usually  contains  urine  and 
this  may  be  passed  immediately  after  birth  or  not  until 
several  hours  later.  After  the  first  urination  the  bladder 
may  be  emptied  five  or  six  times  a  day  or  oftener. 

The  Cord.  Within  a  few  days  after  birth  the  stump  of 
the  umbilical  cord  that  is  attached  to  the  baby's  navel. 


THE  MOTHER'S  CARE  OF  HER  BABY   155 


begins  to  shrivel  and  turn  black  and  a  red  line  a[)|)ears 
where  the  cord  joins  the  abdomen.    By  the  eighth  or  tenth 


Fig.  44. — Appearance  of  cord  four  days  after  birth. 

day,  as  a  rule,  the  cord  has  shrunken  to  a  dry.  black  string, 
when  it  drops  off  and  leaves  an  ulcer  or  small  red  area 


Fig.  45. — Appearance  of  navel  immediately  after  cord  has  dropped  off. 

which  heals  entirely  in  the  course  of  a  few  days.    Figs.  43, 
44,  45  and  46  show  these  progressive  changes. 


156        GETTING  READY  TO  BE  A  MOTHER 

Skin.  The  soft,  downy  hair  that  may  be  remaining  on 
the  surface  of  the  body  usually  disappears  by  the  end  of 
the  first  week  and  there  is  often  a  sealing  of  the  skin  which 
lasts  for  two  or  three  weeks,  while  a  delicate  pink  tint 
replaces  the  deeper  color  of  the  skin  in  the  course  of  ten 
days  or  two  weeks.  The  baby  does  not  perspire  until  after 
the  first  month,  ordinarily,  when  a  very  slight  perspira- 
tion begins,  gradually  increasing  until  by  the  time  the  baby 
is  a  few  months  old  he  is  perspiring  freely. 


Fig.  46. — Appearance  of  a  normal,  Avell  healed  naveL 

Tears.  There  are  no  tears  at  birth  and  opinions  differ  as 
to  whether  tbej^  appear  in  the  course  of  two  or  three  weeks 
or  three  or  four  months.  The  absence  of  tears  is  one  reason 
for  bathing  the  baby's  eyes  so  carefully  during  the  early 
days  and  weeks,  for  if  dust  or  other  foreign  material 
gets  into  the  eyes  it  is  not  washed  out  by  tears  as  it  is  after 
their  flow  is  established. 

General  Behavior.  During  the  first  few  weeks  the 
average  baby  sleeps  most  of  the  time ;  that  is,  from  19  to  21 
hours  daily.    He  gradually  sleeps  less,  as  the  special  senses 


THE  MOTHER'S  CARE  OF  HER  BABY   157 

develop  and  will  sometimes  lie  quietly  for  an  hour  or  more 
with  his  eyes  open,  sleeping  only  16  or  18  hours,  daily,  at 
six  months  and  14  to  16  hours  at  the  end  of  a  year. 

The  baby  begins  to  make  noises  and  "coo"  at  about  two 
months  and  to  utter  various  vowel  sounds  when  about  six 
montlis  old.  By  the  end  of  a  year  these  indefinite  noises 
and  sounds  become  distinct  words.  At  about  the  fourth 
month  he  grasps  at  objects  and  smiles,  and  very  soon  even 
laughs.  He  holds  up  his  head  at  about  the  third  or  fourth 
month ;  sits  up  and  also  begins  to  creep  at  six  or  seven 
months,  while  sometime  between  the  ninth  and  twelfth 
months  he  will  stand  while  holding  on  to  something  secure 
and  begin  to  walk  with  assistance. 

These  degrees  of  development  at  different  ages  are  not 
to  be  taken  as  the  only  measure  of  normal  progress,  for  some 
well  babies  mature  more  rapidly  and  many  others  more 
slowly  than  at  the  rate  which  is  found  to  be  average.  In 
addition  to  these  fairly  specific  evidences  of  the  baby's 
condition  and  progress,  such  as  weight,  height,  strength 
and  muscular  development,  there  are  other  and  less  definite 
indications  of  his  well-being  which  should  be  taken  into 
account. 

The  baby  who  is  well  and  is  being  properly  fed  in  all 
respects,  will  have  good  color ;  his  flesh  will  be  firm ;  he  will 
take  his  nourishment  with  a  certain  amount  of  eagerness 
and  seem  satisfied  afterwards.  He  will  sleep  for  two  or 
three  hours  after  each  feeding;  will  sleep  quietly  at  night 
and  while  awake,  unless  he  is  wet  or  uncomfortable  for  some 
other  good  reason,  he  will  seem  contented,  good-natured 
and  happy. 

You  have  seen  how  the  average,  well  baby  grows  and  de- 
velops, provided  he  is  given  proper  care.  I  want  you  now 
to  have  just  a  glimpse  of  the  other  side  of  the  question,  so 
that  you  may  realize  what  happens  to  the  unfortunate  little 


158        GETTING  READY  TO  BE  A  MOTHER 

citizens  who  are  not  given  such  care.  This  glimpse  will 
make  you  realize  more  than  ever,  how  worth  while  are  all 
of  the  precautions  that  you  take  for  your  baby. 

It  is  estimated  that  out  of  every  1000  babies  born  alive, 
in  this  country,  40  die  during  the  first  month  of  life,  and 
that  more  than  as  many  again,  or  about  85  all  told,  perish 
before  reaching  the  first  birthday. 

So  hazardous  is  this  period  of  early  infancy,  in  the  United 
States,  that  our  annual  loss  of  baby  life  is  between  seven 
and  eight  times  as  great  as  was  the  yearly  loss  of  our  young 
men  in  the  war,  for  upwards  of  200,000  babies  less  than  a 
year  old  die  each  year.  That  the  first  month  is  more  dan- 
gerous than  any  which  follow  is  shown  by  the  fact  that 
about  100,000  of  these  baby  deaths  occur  during  the  first 
four  weeks  of  life.  The  tragedy  of  these  figures  is  made 
darker  by  the  fact  that  at  least  half  of  the  babies  who  are 
lost  die  from  preventable  causes.  In  other  words,  they 
die  from  lack  of  proper  care. 

That  is  the  point  of  this  for  you.  These  babies  die,  not 
by  an  act  of  Providence,  but  from  lack  of  care — not  the 
difficult,  complicated  care  needed  by  sick  babies  but  just  the 
everyday  care  which  any  mother  may  give — the  care  that 
keeps  wein)abies  well. 

That  is  what  you  are  going  to  do — keep  your  well  baby 
well.  And  you  are  going  to  be  surprised  to  find  how  easy  it 
is,  after  all,  to  say  nothing  of  the  pleasure  of  it,  for  the 
thing  very  nearly  sums  itself  up  into  feeding  your  baby 
as  the  doctor  orders  and  keeping  him  clean  in  every  par- 
ticular. Bear  these  two  factors  in  mind  for  errors  in  feed- 
ing and  lack  of  cleanliness  are  the  underl^nng  causes  of 
the  vast  majority  of  baby  ills. 

You  will  often  feel  a  little  like  Alice  in  Wonderland, 
who  found,  one  time,  that  she  had  to  keep  running  very 
fast  to  stay  where  she  was,  for  you  will  not  be  able  to 


THE  MOTHER'S  CARE  OF  HER  BABY   I.IO 

relax  in  a  single  detail  of  youi-  baby's  care  if  yoii  inc  1o 
keep  him  well.  With  him,  as  witii  you,  or  anyone  else, 
the  satisfactory  use  of  even  ideal  food  is  largely  dejiendent 
upon  the  general  condition  and  mode  of  living,  and  we  find 
accordingly,  that  the  (|uestion  of  keeping  the  baby  well 
finally  resolves  itself  into  the  following  common  sense  re- 
quirements : 

1.  Proper  food. 

2.  Fresh  air. 

3.  Regularity  in  the  daily  routine  care. 

4.  Cleanliness  of  food,  clothing  and  surroundings. 

5.  Preservation  of  an  even  body  temperature. 
G.  Adequate  rest  and  sleep. 

7.  Periodic  consultations  with  your  doctor. 

Carve  these  principles  into  the  tablets  of  your  brain 
and  you  cannot  fail  to  give  your  baby  the  kind  of  care 
that  is  literally  life-saving.  I  am  going  to  describe  the 
tiny,  intimate  details  of  this  care,  for  I  think  this  will  help 
you,  in  the  beginning  at  least,  but  if  you  will  keep  these 
fundamentals  in  mind  and  use  good  common  sense  you 
really  need  not  read  another  word  about  baby  care,  for 
they  give  it  all  in  a  nutshell. 

Let  me  warn  you  emphatically  against  making  the  very 
serious  mistake  of  acting  upon  the  advice  of  friends  or 
relatives,  no  matter  how  many  children  they  have  had. 
These  counselors  are  just  as  dangerous  for  babies  as  they 
are  for  expectant  mothers,  so  beware  of  them ! 

"Is  it  not  preposterous,"  says  Herbei't  8pencer,  "that  the  fate 
of  a  new  generation  should  be  left  to  the  chance  of  unreasoning 
custom,  impulse,  fancy,  joined  with  the  suggestions  of  ignorant 
nurses  and  the  prejudiced  counsel  of  grandmothers?  To  tens  of 
thousands  that  are  killed,  add  hundreds  of  thousands  that  sur- 
vive with  feeble  constitutions,  and  millions  that  grow  up  with 
constitutions  not  so  strong  as  they  should  be,  and  you  have  some 


160        GETTING  READY  TO  BE  A  MOTHER 

idea  of  the  curse  inflicted  on  their  offspring  by  parents  ignorant 
of  the  laws  of  life." 

It  is  a  very  wise  precaution  to  have  your  doctor  see 
the  baby  every  week  or  ten  days  during  the  first  three 
months  and  once  a  month  during  the  remainder  of  the 
year.  Not  because  he  is  fragile  or  ill.  Not  at  all.  You 
consult  your  doctor  in  order  to  be  sure  that  you  are  keeping 
your  hahy  well. 

Did  you  ever  hear  of  the  Chinese  custom  of  paying  the 
doctor  as  long  as  one  is  well,  but  not  paying  for  attention 
during  illness?  It  isn't  so  very  heathenish — that  idea  of 
paying  for  the  skillful  care  that  will  prevent  illness. 

In  addition  to  taking  the  general  precaution  of  seeing 
your  doctor  periodically,  about  the  baby,  be  sure  to  consult 
him  about  anything  that  you  do  not  understand  or  about 
any  new  condition  that  arises.  You  will  find  any  number 
of  persons  who  are  ready  and  eager  to  advise  you,  but  your 
doctor  is  the  only  one  whose  advice  it  is  safe  for  you  to 
follow. 

The  Daily  Schedule.  The  importance  of  regularity  in 
the  daily  routine  of  the  baby's  care  cannot  be  stressed  too 
often  nor  too  insistently.  No  matter  how  well  he  is  nursed 
in  other  respects,  nor  how  skillfully  the  doctor  directs  his 
care,  the  baby  cannot  be  expected  to  progress  satisfactorily 
if  his  life  is  not  absolutely  regular. 

Begin  by  arranging  a  daily  program  for  the  feedings, 
fresh  air,  bath,  sleep  and  exercise  and  then  allow  nothing 
to  interfere  with  your  carrying  it  out. 

The  hours  for  the  nursings,  which  vary  with  different 
doctors,  will  constitute  the  greater  part  of  this  daily  sched- 
ule. For  a  baby  on  four  hour  feedings,  for  example,  some 
such  program  as  the  following  may  be  arranged,  while 
for  a  baby  on  a  three  hour  schedule  a  slightly  different  pro- 
gram may  be  arranged. 


THE  MOTHER'S  CARE  OF  HER  BABY   161 


6 

a.m. 

J"'eeding:. 

8 

a.m. 

Orange  juice  (when  ordered). 

9 

a.m. 

Bath. 

10 

a.m. 

Feediufj'. 

10:30  to   2 

p.m. 

Out  of  doors. 

2 

p.m. 

Feediuij-. 

2:30  to   4 

p.m. 

Out  of  doois. 

4 

p.m. 

Orange  juice  (when  ordered). 

4  to   5:30 

1  p.m. 

Indoor  airing  and  exercises  (when  ordered) 

5:3C 

•  p.iu. 

Preparation  for  the  night. 

6 

p.m. 

Feeding. 

10 

l).m. 

Feeding. 

2 

a.m. 

P"'eeding  (when  ordered). 

YOUR  BABY'S  FOOD 

Proper  feeding  is  probably  the  most  decisive  single  fac- 
tor in  the  routine  care  of  the  baby. 

In  order  that  the  food  shall  be  satisfactory,  it  must  be 
not  only  suitable  in  composition  for  the  individual  baby, 
but  it  must  be  clean,  fresh  and  at  the  right  temperature ; 
given  in  suitable  amounts  and  at  suitable  intervals ;  it  must 
be  given  properly — not  too  fast  nor  too  slowly  and  it  must 
be  given  under  favorable  conditions.  Moreover,  as  has  been 
stated,  the  babj^  himself,  must  be  kept  in  a  general  con- 
dition which  will  promote  the  digestion  and  assimilation  of 
the  food  that  is  given  to  him.  Fresh  air,  suitable  clothing, 
an  even  body  temperature,  gentle  handling,  proper  bath- 
ing, regular  sleep,  freedom  from  excitement,  fatigue  and 
irritation  all  promote  the  bady's  ability  to  use  his  food  to 
advantage.  Reverse  conditions  all  work  against  it.  Ac- 
cordingly, the  actual  value  of  the  baby's  food  to  him 
will  be  largely  dependent  upon  the  care  that  you  give  him. 

There  are  three  methods  of  nourishing  the  baby :  by 
breast  feeding,  by  artificial  feeding  and  by  a  combination 
of  the  two,  termed  mixed  or  supplementary  feeding. 


162        GETTING  READY  TO  BE  A  MOTHER 

Breast  Feeding.  From  all  standpoints,  maternal  nurs- 
ing, under  normal  conditions,  is  the  most  satisfactory  meth- 
od of  nourishing  a  baby.  H  the  breast  milk  is  suitable  it 
meets  all  of  the  baby's  requirements  and  the  proportion 
and  character  of  its  constituents  are  exactly  suited  to  his 
digestive  powers.  In  order  for  maternal  nursing  to  be 
entirely  satisfactory,  the  condition  of  both  mother  and 
baby  must  be  favorable.  The  preparation  and  care  of  the 
mother  have  been  described :  her  general  condition  and 
state  of  nutrition;  the  care  and  condition  of  her  nipples, 
flat  or  retracted  nipples  being  brought  out  if  possible,  and 
if  not,  the  nursing  facilitated  by  the  use  of  a  shield.  As 
to  the  baby,  if  his  diaper  is  wet  or  soiled,  it  should  be 
changed  before  he  is  put  to  the  breast,  partly  to  make  him 
comfortable  and  partly  to  avoid  disturbing  him  for  this 
after  his  feeding;  and  his  mouth  is  gently  swabbed  with 
boric-soaked  cotton,  if  your  doctor  so  orders.^ 

Although  nursing  is  an  instinct,  the  baby  may  have  to 
learn  how  to  nurse  or  to  acquire  the  habit,  this  being  one 
reason  fur  putting  him  to  the  breast  during  those  first  two 
or  three  days  when  he  obtains  little  or  no  actual  food,  as 
was  explained  in  Chapter  IX.  As  he  expresses  the  milk  by 
squeezing  and  suction  made  possible  only  when  the  nipple 
is  well  back  in  his  mouth,  he  must  take  into  his  mouth 
practically  the  entire  colored  area  which  surrounds  the  nip- 
ple. To  do  this  he  lies  in 'the  curve  of  his  mother's  arm 
as  she  turns  slightly  to  one  side,  and  holds  her  breast  away 
from  his  nostrils  in  order  that  he  may  breathe  freely. 

Sometimes,  even  when  other  conditions  are  favorable, 
the  baby  is  unable  to  nurse  because  of  some  physical  dis- 
ability. He  may  be  too  feeble,  may  have  a  cleft  palate 
or  find  suckling  painful  because  of  an  injury  to  the  mucous 

^  Boracic  acid  solution  is  made  by  adding  one  teaspoonf  ul  of  the 
crystals  to  one  cup  (half -pint)  of  Vjoiling  water. 


THE  MOTHER  S  CARE  OF  HER  BABY   163 

membrane  Avhich  occurred  when  his  mouth  was  wiped  out 
just  after  birth.  The  manner  in  which  the  baby  nurses, 
therefore,  may  be  significant  and  should  be  described  to 
the  doctor  if  there  is  any  difficulty. 

When  the  baby  has  finished  nursing  he  should  be  taken 
up  very  gently,  held  upright  against  the  shoulder  for  a 
moment  or  two,  to  help  him  bring  up  gas  if  he  has  any, 
and  then  placed  in  his  crib  and  left  to  sleep.  If  he  is 
nursing  satisfactorily,  he  will  be  sleepy  and  contented 
afterwards  and  Avill  sleep  for  two  or  three  hours;  he  will 
seem  generally  good-humored  and  comfortable  while 
awake;  he  will  have  good  color;  gain  weight  steadily  and 
have  two  or  three  normal  bowel  movements  daily.  The 
normal  stool  in  breast-fed  babies  is  bright  yellow,  smooth 
and  has  no  evidences  of  undigested  food. 

If  the  baby  is  not  being  adequately  nourished,  he  will 
present  exactly  the  opposite  picture,  in  some  or  all  of 
these  respects.  He  will  be  unwilling  to  stop  nursing  after 
the  normal  length  of  time  and  will  give  evidence  of  being 
not  satisfied  when  taken  from  the  breast.  He  may  be  list- 
less and  fretful  and  sleep  badly.  He  wall  not  gain  weight 
as  he  should  and  he  may  vomit  or  have  colic  after  nursing. 

To  ascertain  whether  or  not  such  a  baby  is  getting  enough 
milk  it  is  customary  to  weigh  him,  without  undressing  him, 
before  and  after  each  nursing.  Each  fiuid  ounce  of  milk 
will  increase  his  weight  one  ounce.  If  the  baby  is  not  ob- 
taining a  normal  amount  of  milk  at  each  nursing,  he  is 
often  given  enough  modified  milk  after  each  meal  to  supply 
the  shortage,  but  at  the  same  time  an  effort  is  made  to  in- 
crease the  supply  of  breast  milk  by  improving  the  mother's 
personal  hygiene,  as  described  in  Chapter  IX. 

The  amount  which  the  baby  needs  at  each  feeding  varies, 
not  only  according  to  his  weight  and  age,  but  also  accord- 
ing to  his  vigor  and  activitv  and  therefore  must  be  esti- 


164        GETTING  READY  TO  BE  A  MOTHER 

mated  for  each  baby.  A  very  general  estimate  of  the 
amount  taken  by  the  average,  well  baby  at  each  feeding, 
is  about  as  follows : 

First  week   11/2  to  21/2  ounces 

Second  and  third  week 2      to  4      ounces 

Fourth  to  ninth  week 3      to  4^  ounces 

Tenth  week  to  fifth  month 3V2  to  5      ounces 

Fifth  to  seventh  month 4V2  to  6V2  ounces 

Seventh  to  twelfth  month 6V2  to  9      ounces 

Artificial  Feeding.  There  is  no  entirely  adequate  substi- 
tute for  satisfactory  maternal  nursing,  and  any  other  food 
that  is  given  to  the  young  baby  is  at  best  a  makeshift. 
Considering  the  baby's  delicacy,  therefore,  and  his  urgent 
needs,  no  pains  should  be  spared  to  make  any  artificial 
food  that  is  given  to  him,  as  satisfactory  as  possible.  And 
no  matter  what  it  costs,  he  should  have  only  the  freshest, 
cleanest  and  purest  milk  that  can  be  bought. 

In  preparing  and  giving  artificial  food  it  must  be  borne 
in  mind  that  normal  breast  milk  has  the  following  charac- 
teristics : 

1.  It  is  exactly  right  in  (juantity,  quality  and  proportion. 

2.  It  is  fresh,  clean  and  sweet. 

3.  It  is  free  from  bacteria. 

4.  It  tends  to  protect  the  baby  fi'om  infection. 

5.  It  definitely  protects  him  from  certain  nutritional  diseases. 

Cows'  milk,  suitably  modified,  is  apparently  the  best 
available  substitute  for  mother's  milk,  but  it  must  first 
meet  certain  requirements  and  then  be  handled  with  scrup- 
ulous cleanliness  and  care,  if  it  is  to  be  satisfactory. 

The  requirements  are  that  the  milk  shall  be : 

1.  Whole  milk.  It  must  not  be  altered  by  the  removal  of 
cream  nor  the  addition  of  such  preservatives  as  salicylic 
acid,  formaldehyde  or  boracic  acid. 


THE  MOTHER'S  ("AUH  OK   IIEK  liAllV       Ki.") 

2.  Its  composition  imist   not  vary  greatly  I'roni  day  tn  <lay. 

3.  It  must  be  clean  an<l   free  from  disease  germs;  other  or- 
ganisms should  not  be  jiresent  in  excessive  numbers. 

4.  It    must    be    fresh :    less    than    24    hours    old    when   it    is 
delivered. 

All  of  this  means  that  the  milk  must  eome  from  a  herd 
of  healthy,  tuberculin-tested  cows.  The  milk  from  a  single 
cow  may  vary  markedly  from  day  to  day  but  that  from 
several  cows  is  nearly  constant.  The  stables  and  the  cows 
must  be  kept  clean,  the  udders  carefully  washed  before 
each  milking;  the  milkers  themselves  must  wear  freshly 
washed  clothing,  scrub  their  hands  thoroughly  and  milk 
into  sterile  receptacles;  the  milk  must  be  immediately 
covered  and  cooled  to  a  temperature  of  45°  F.  or  50°  F, 
and  kept  there. 

]\Iilk  produced  under  such  conditions  is  usually  de- 
scribed as  "certified  milk"  and  is  often  prescribed  as  infant 
food  without  being  pasteurized  or  sterilized.  But  if  there 
is  any  doubt  about  the  source  of  the  milk  and  the  method 
of  its  handling,  it  should  be  strained  into  a  clean  receptacle 
through  filter  paper  or  a  thick  layer  of  absorbent  cotton 
and  subsequently  boiled  or  pasteurized. 

"Whether  certified  or  not,  the  milk  should  invariably  be 
placed  in  the  refrigerator,  or  some  other  place  which  has  a 
temperature  of  50°  F.,  as  soon  as  it  is  received,  and  it  mu^t 
he  kept  cool  and  clean. 

Keeping  milk  cool  means  keeping  it  at  a  temperature  of 
50°  F.  Keeping  it  clean  implies  cleanliness  not  alone  of 
the  milk  itself  but  of  your  hands  and  the  utensils  that  you 
use  as  well  as  the  destruction  of  disease  germs  by  pasteuri- 
zation or  sterilization.  Among  the  germs  which  are 
likely  to  be  present  in  infected  milk  are  those  that  cause 
diarrhea,  sore  throats,  typhoid  fever,  diphtheria  and  scar- 
let fever. 


166       GETTING  READY  TO  BE  A  MOTHER 

When  the  doctor  makes  out  the  formula  for  the  baby's 
milk,  he  will  adjust  the  proportions  of  the  different  ingre- 
dients to  the  baby 's  immediate  needs  and  digestive  powers. 
But  his  careful  estimations  will  be  set  at  naught  unless 
you  are  absolutely  accurate  in  preparing  and  giving  the 
milk.  Your  invariable  responsibility  in  connection  with  the 
baby's  milk,  therefore,  is  to  keep  it  cool  and  clean  and  be 
accurate. 

You  will  appreciate  the  necessity  for  modifying  cows" 
milk  before  giving  it  to  your  baby  if  you  will  note  the 
differences  between  mother's  milk  and  cows'  milk  as  indi- 
cated by  the  following  table  and  consider,  too,  why  Nature 
has  made  these  differences : 

Mother's  Milk  Cows'  Milk 

Fats    3.5  to    4.    percent  3.5  to    4.      percent 

Sugar     6.5  to    7.5  per  cent  4.5  to    4.75  per  cent 

Proteins   1.    to    1.5  percent  3.5  to    4.      per  cent 

Salts   .2  per  cent  .7  to      .75  per  cent 

Water  87     to  88.    per  cent  87.      per  cent 

The  various  tissues  of  the  body  and  the  bony  skeleton  are 
built  by  the  proteins  and  salt.  Accordingly  Nature  sup- 
plies these  in  greater  abundance  to  the  baby  calf,  who 
grows  so  fast  as  to  double  his  birth  weight  in  about  forty- 
seven  days,  than  to  the  baby  boy  who  scarcely  doubles  his 
birth  weight  within  180  days.  The  calf  begins  life  with  a 
physical  need  for  the  large  amount  of  proteins  and  salts 
which  are  present  in  cows'  milk  and  with  digestive  organs 
that  can  cope  with  them,  but  the  baby  needs  less,  can  digest 
less  and,  therefore,  should  be  given  less.  There  are  of 
course,  other  and  finer  differences  between  the  two  milks 
and  an  attempt  is  sometimes  make  to  meet  these.  For  ex- 
ample, mother's  milk  is  slightly  alkaline  and  cows'  milk 
slightly  acid  and  the  curd  of  cows'  milk  is  larger,  tougher 


THE  MOTHER  S  CARE  OF  HER  BABY   167 

and  harder  to  digest  than  that  formed  by  mother's  milk. 
Some  doctors  add  lime  water  to  cows'  milk,  before  giving 
it  to  the  baby,  to  make  it  alkaline  and  have  the  curd  made 
softer,  finer  and  more  digestible  by  boiling. 

Articles  Needed  in  Preparing-  the  Baby's  Food.  A  com- 
plete equipment  for  preparing  and  giving  tlie  baby's  milk 
shonld  be  assembled,  kept  in  a  clean  place,  separate  from 
ntensils  in  general  nse,  and  never  put  to  any  other  service. 
A  satisfactory  outfit  for  this  ]nirpose  comprises  the  follow- 
ing articles : 

One  dozen   ui'aduated  nur.^ing  bottles. 

One  dozen  nipples. 

Clean,  new  corks  or  a  jiackage  of  sterile,  non-absorbent  cot- 
ton for  stoppers. 

Bottle  brnsh. 

Covered  kettle,  capacity  one  gallon,  for  boiling  bottles  and 
possibly  pasteurizing  milk. 

Pasteurizer  or  wire  bottle  rack. 

Small  kettle,  about  one  quart  size. 

Graduated  pint  or  quart  measuring  glass. 

Pitcher,  two  quart  size. 

Lons-handled  spoon  for  mixing. 

Funnel. 

Measuring  spoons — table  and  tea  sizes. 

Double  boiler. 

Thermometer  which  will  register  at  least  212°  F. 

Cream  dipper  (if  ordered). 

Two  small  covered  jars  for  sterile  and  used  nipples. 

Sugar  (lactose,  maltose  or  cane  sugar  according  to  orders). 

Lime  water  ( if  ordered ) . 

Utensils  of  enamel  or  aluminum  ware  are  probably  the 
most  satisfactory  ones  to  use  as  they  are  easily  kept  clean, 
while  bottles  with  wide  mouths  and  curved  bottoms  and  in- 
ner surfaces  can  be  thoroughly  washed  more  easily  than 


168       GETTING  READY  TO  BE  A  MOTHER 

those  with  small  necks  and  sharp  corners.  Nipples  that 
can  be  turned  inside  out  to  be  washed  should  be  selected 
as  it  is  almost  impossible  to  clean  thoroughly  those  with 
tubes  or  narrow  necks.  New  bottles  will  be  rendered  less 
breakable  if  placed  in  cold  water,  which  is  gradually 
heated,  allowed  to  boil  for  half  an  hour  and  cooled  before 
the  bottles  are  removed. 

The  bottles  should  be  rinsed  with  cold  water  after  each 
feeding  and  then  carefully  washed  and  scrubbed  with  the 
bottle  brush  in  hot  soap.mds  or  borax  water,  containing  two 
tablespoonfuls  to  the  pint.  They  may  be  kept  full  of  water 
while  not  in  use  or  rinsed  with  hot  water  and  stood  upside 
down  until  they  are  all  boiled  on  the  following  morning, 
preparatory  to  being  filled  with  the  freshly  prepared  milk. 
The  baby 's  bottles  should  never  be  washed  in  dishwater  nor 
dried  on  a  towel.  The  nipples  should  be  rinsed  in  cold 
water,  turned  inside  out  and  scrubbed  with  a  brush,  in 
hot  soapsuds  or  borax  water;  rinsed  and  placed  in  a  jar 
ready  to  be  boiled  with  the  bottles. 

Preparing  the  Milk.  The  full  quantity  of  milk  which  the 
baby  will  take  in  the  course  of  twenty-four  hours  is  pre- 
pared at  one  time  and  the  prescribed  amount  for  each 
feeding  poured  into  as  many  separate  bottles  as  there  will 
be  feedings. 

You  should  begin  by  assembling  on  a  table  everything 
that  you  will  use  in  preparing  the  milk  formula,  as  the 
nurse  has  in  Fig.  47.  Boil  for  five  minutes  all  of  the 
articles  that  will  come  in  contact  with  the  milk,  including 
the  full  number  of  bottles  and  nipples  and  the  jars  in  which 
the  nipples  are  kept ;  remove  them  with  the  long-handled 
spoon  without  touching  the  edges  or  inner  surfaces,  drop- 
ping the  nipples  into  one  of  the  sterile  jars. 

Wash  the  mouth  of  the  milk  bottle  before  removing  the 
cap  and  pour  the  amount  which  the  formula  calls  for  into 


THE  MOTHER'S  CARE  OF  HKll  IJAliV       l(i9 

the  sterile  pitcher.  To  this  is  added  thc^  sterile  water  in 
which  the  sugar  has  been  dissolved  in  the  measuring  glass 
and  then  the  liotato  or  barley  water,  the  lime  water  or  soda 
solution  as  ordered.  This  mixture  is  thoroughly  stirred 
and  the  amount  for  one  feeding  at  a  time,  measured  in 


Fig.  47. — Preparing  the  baby's  milk.     (From  a  photograph  taken  at 
Johns  Hopkins  Hospital.) 

the  measuring  glass  and  poured  into  the  specified  number 
of  bottles,  which  are  then  stoppered. 

If  certified  milk  is  used  for  the  milk  mixture  it  is  often 
given  to  the  baby  w'ithout  being  pasteurized,  in  which  case 
the  bottles  are  placed  in  the  refrigerator  as  soon  as  they  are 
filled  and  stoppered.  Very  frequently,  however,  the  milk 
is  sterilized  or  pasteurized.     You  will  fe<>l  surer  of  keejiing 


170        GETTING  READY  TO  BE  A  MOTHER 

the  mouths  of  the  bottles  clean  if  you  cover  them  with 
squares  of  gauze  or  muslin  before  they  are  sterilized,  hold- 
ing the  caps  in  place  with  tapes  or  rubber  bands. 

Pasteurization  as  applied  to  infant  feeding  consists  of 
heating  the  milk  to  140-165°  F.  and  keeping  it  at  that  tem- 
perature for  20  to  30  minutes. 

There  are  many  excellent  pasteurizers  for  home  use  on 
the  market,  but  entirely  satisfactory  results  may  be  obtained 
by  improvising  one  from  the  wire  bottle  rack  seen  in  Fig.  47, 
and  the  large  kettle  already  provided.  One  method  is  to 
place  the  rack,  containing  the  bottles,  in  the  kettle  which  is 
filled  with  cold  water  to  a  level  a  little  above  the  top  of  the 
milk  in  the  bottles,  and  allow  the  water  to  come  to  the 
boiling  point.  The  kettle  is  removed  from  the  fire,  covered 
tightly  and  the  bottles  allowed  to  stand  in  the  hot  water 
for  twenty  minutes.  Cold  water  is  then  run  into  the  kettle 
to  cool  the  milk  gradually  and  avoid  breaking  the  bottles, 
after  which  they  are  placed  in  the  refrigerator,  well  or 
spring-house  and  kept  at  a  temperature  of  50°  F.  until 
they  are  taken  out,  one  at  a  time,  for  feedings.  If  a  wire 
rack  is  not  available  the  bottles  may  be  stood  on  a  saucer 
or  a  thick  pad  of  folded  newspapers  in  the  bottom  of  the 
kettle. 

Pasteurization  does  not  destroy  all  germs  that  may  be  in 
the  milk,  but  it  kills  the  more  important  ones  and  appar- 
ently impairs  the  nutritive  and  protective  properties  of  the 
milk  less  than  boiling.  However,  pasteurized  milk  must  be 
kept  cold  and  must  be  used  within  twenty-four  hours,  for 
the  aging  of  milk  is  quite  as  undesirable  as  souring. 

Scalding  is  another  method  of  destroying  germs  in  milk. 
The  milk  is  placed  in  an  open  vessel  and  the  temperature 
raised  to  about  180°  F.,  or  until  bubbles  appear  around  the 
edge  and  the  milk  steams  in  the  center,  after  which  it  is 
cooled  and  kept  at  a  temperature  of  50°  F. 


THE  MOTHER'S  CARE  OF  HER  BABY   171 

Many  doctors  prefer  to  have  the  baby's  milk  boiled,  since 
boiling  insures  absolute  sterilization  and  also  renders  the 
curd  more  digestible.  Other  changes  are  produced  by  boil- 
ing, however,  which  make  it  important  to  add  orange  juice 
and  cod-liver  oil  to  the  baby's  diet  at  an  early  date,  as 
will  be  explained  in  the  next  chapter. 

Milk  may  be  boiled  directlj^  over  the  tiame  for  a  time 
varying  from  three  to  forty-five  minutes,  or  it  may  be 
placed  in  a  double  boiler,  the  water  in  the  lower  receptacle 
being  cold,  and  allowed  to  remain  until  the  water  has 
boiled  from  six  to  forty-five  minutes. 

When  milk  is  boiled  or  scalded,  the  other  ingredients  are 
added  beforehand,  as  a  rule,  after  which  it  is  measured  and 
poured  into  the  bottles.  Or  the  milk  mixture  may  be 
poured  into  the  bottles  as  for  pasteurization  and  the  bottles 
kept  in  the  actively  boiling  water  for  any  desired  length 
of  time. 

All  of  these  points,  however,  are  definitelj^  specified  by 
the  doctor. 

Giving  the  Baby  His  Bottle.  At  feeding  time,  the  bottle 
should  be  taken  from  the  refrigerator^  the  stopper  removed 
and  a  sterile  nipple  taken  up  by  the  margin  and  put  on 
the  bottle  without  touching  the  mouthpiece.  The  milk  is 
brought  to  a  temperature  of  about  100°  F.  by  standing  the 
bottle  in  a  deep  cup  or  kettle  of  warm  water  and  placing 
it  on  the  fire.  The  temperature  of  the  milk  may  be  tested 
by  dropping  a  few  drops  on  the  inner  side  of  the  wrist  or 
forearm  where  it  should  feel  warm  but  not  hot.  This 
dropping  will  also  indicate  if  the  hole  in  the  nipple  is  of 
the  proper  size  to  allow  the  milk  to  drop  rapidly  in  clean 
drops  but  not  to  pour.  If  the  hole  is  too  small,  the  drops 
will  be  small  and  infrequent  and  the  baby  will  be  obliged 
to  work  too  hard  to  obtain  it ;  Avhile  if  the  hole  is  too  large 
the  baby  W'ill  feed  too  rapidly  and  may  have  colic  as  a 


172        GETTING  READY  TO  BE  A  MOTHER 


result.  If  the  hole  is  too  large  the  nipple  will  have  to  be 
discarded;  if  too  small  or  if  there  is  no  hole,  one  of  the 
proper  size  may  be  made  by  piercing  the  nipple  with  a 
heated  darning  needle  or  small  steel  knitting  needle. 


Fig.  48.— Proper  position  in  which  to  hold  baby  and  botth^  during 

feeding. 


THE  MOTHER'S  CARE  OF  HER  BABY   173 

The  baby's  diaper  should  be  changed  if  it  is  soiled  or 
wet  before  he  is  given  the  bottle  and  he  should  be  held  com- 
fortnblv  on  vonr  arm,  in   a  reclining  position,   while  you 


Fig.  49. — Holding  the  baby  upright  immediately  after  feeding, 
and  gently  patting  his  back  to  help  him  bring  up  air  in  order  to 
prevent  colic. 

hold  the  bottle  Avith  your  free  hand  as  shown  by  the  nurse 
in  Fig.  48.  The  bottle  should  be  inclined  sufficiently  to 
keep  the  neck  full  of  milk ;  otherwise  the  baby  may  draw  in 
air  as  he  nurses.     He  should  be  kept  awake  while  feeding 


174       GETTING  READY  TO  BE  A  MOTHER 

but  he  should  be  allowed  to  pause  every  three  or  four  min- 
utes in  order  not  to  take  his  milk  too  rapidly.  Not  less 
than  ten  nor  more  than  twenty  minutes  is  devoted  to  a 
feeding,  as  a  rule,  and  if  the  baby  refuses  a  part  of  his 
milk,  it  should  be  thrown  away;  never  warmed  over  for 
another  time. 

After  being  fed,  the  baby  should  be  held  ujiright  against 
your  shoulder  for  a  moment  or  two,  as  in  Fig.  49,  and  ever 
so  gently  patted  on  the  back  to  help  bring  up  any  air 
which  he  may  have  swallowed.  He  should  on  no  account 
be  rocked  nor  played  with  after  taking  the  bottle,  but  should 
be  placed  gently  in  his  crib,  warm  and  dry  and  left  alone 
to  sleep.  Turning  him  or  moving  him  about  even  to  the 
extent  of  changing  his  diaper  at  this  time  may  cause  vomit- 
ing. 

The  evidences  of  satisfactory  and  unsatisfactory  feeding 
in  the  bottle-fed  baby  are  about  the  same  as  in  the  baby 
who  is  fed  at  the  breast,  except  that  the  gain  in  weight  on 
artificial  food  may  be  a  little  slower  and  less  steady  than  on 
maternal  nursing ;  the  stools  have  a  characteristic  sour 
odor;  are  a  little  lighter  in  color  and  may  contain  white 
lumps  of  undigested  fat ;  are  usually  dryer  than  in  breast- 
feeding and  may  be  formed,  in  even  a  very  young  baby. 

IMany  doctors  feel  that  all  babies,  whether  breast-fed 
or  on  the  bottle,  require  a  certain  amount  of  cool  boiled 
water  to  drink  between  feedings.  A  small  amount  is  given 
at  first  and  gradually  increased  according  to  the  doctor's 
instructions,  and  it  may  be  given  from  a  bottle,  a  medicine 
dropper  or  poured  slowly  from  the  tip  of  a  teaspoon. 

I  feel  sure  that  you  have  realized,  long  before  this,  that 
the  entire  question  of  planning  the  baby's  food  is  such  an 
important  and  complicated  matter  that  it  cannot  with 
safety  to  the  baby  be  undertaken  by  any  one  but  your  doc- 
tor.    Unexpected  situations  do  arise,  however,  when  the 


THE  MOTHER'S  CARE  OF  HER  BAliV       175 

doctor  is  not  within  immediate  reach  and  the  mother  has 
to  phm  the  l)aby'.s  food,  temporarily,  to  the  best  of  her 
ability. 

Should  you  find  yourself  in  such  an  emergency,  you  will 
find  help  in  the  milk  formulas  contained  in  a  pamphlet 
issued  by  the  American  Medical  Association,  remembering 
that  they  are  intended  for  the  average,  normal  baby  and  are 
not  necessarily  suitable  for  all  babies.  A  large,  vigorous 
baby  may  need  more  food  and  a  small,  frail  baby  have  to 
take  less  than  the  amounts  specified  in  the  following  direc- 
tions •} 

"The  simplest  plan  is  to  use  whole  milk  (from  a  shaken 
bottle)  which  is  to  be  diluted  according  to  the  child's  age  and 
digestion. 

"Beginning  on  the  thii'd  day,  the  average  baby  should  be  given 
3  ounces  of  milk  daily,  diluted  with  seven  ounces  of  water.  To 
this  should  be  added  one  tablespoonful  of  lime  water  and  2  level 
teaspoonfuls  of  sugar.     This  should  be  given  in  7  feedings. 

"At  one  week,  the  average  child  requires  5  ounces  of  milk 
daily,  which  should  be  diluted  with  10  ounces  of  water.  To  this 
should  be  added  IV2  even  tablespoonfuls  of  sugar  and  one  ounce 
of  lime  water.     This  should  be  given  in  7  feedings. 

"The  milk  should  be  increased  by  V2  ounce  about  eveiy  4  days. 

"The  water  should  be  increased  by  Y^  ounce  about  every  8 
days. 

"At  3  months  the  average  child  requires  16  ounces  of  milk 
daily,  which  should  be  diluted  with  10  ounces  of  water.  To  this 
should  be  added  3  tablespoonfuls  of  .sugar  and  2  ounces  of  lime 
water.     This  should  be  given  in  6  feedings. 

"The  milk  should  be  increased  by  V-i  ounce  about  every  6 
days. 

"The  water  should  be  reduced  by  V2  ounce  about  everj'  2 
weeks. 

^  From  ' '  Save  The  Babies ' '  by  Dr.  L.  Emmet  Holt  and  Dt.  H.  K. 
L.  Shaw.     Copied  by  courtesy  of  The  American  Medical  Association. 


176        GETTING  READY  TO  BE  A  MOTHER 

"At  6  months  the  average  child  requires  24  ounces  of  milk 
daily,  which  should  be  diluted  with  12  ounces  of  water.  To  this 
should  be  added  2  ounces  of  lime  water  and  3  even  tablespoonfuls 
of  sugar.     This  should  be  given  in  5  feedings. 

"The  amount  of  milk  should  be  increased  by  1/2  ounce  every 
week. 

"The  milk  should  be  increased  only  if  the  child  is  hungry  and 
digesting  his  food  well.  It  should  not  be  increased  unless  he  is 
hungry,  nor  if  he  is  suffering  from  indigestion  even  though  he 
seems  hungry. 

"At  9  months,  the  average  child  requires  30  ounces  of  milk 
daily,  which  should  be  diluted  with  10  ounces  of  water.  To  this 
should  be  added  2  even  tablespoonfuls  of  sugar  and  2  ounces  of 
lime  water.     This  should  be  given  in  5  feedings. 

"The  sugar  added  may  be  milk  sugar  or,  if  this  cannot  be 
obtained,  cane   (granulated)  sugar  or  maltose  (malt  sugar). 

"At  first  plain  water  should  be  used  to  dilute  the  milk. 

"At  3  months,  sometimes  earlier,  weak  barley  water  may 
be  used  in  the  place  of  plain  water;  it  is  made  with  1/2  level 
tablespoonful  of  barley  flour  to  16  ounces  of  water  and  cooked 
20  minutes. 

"At  6  months  the  barley  flour  may  be  increased  to  IV^  even 
tablespoonfuls,  cooked  in  the  12  ounces  of  water. 

"At  9  months,  the  barley  flour  may  be  increased  to  3  level 
tablespoonfuls,  cooked  in  the  10  ounces  of  water. 

"A  very  large  baby  may  require  a  little  more  milk  than  that 
allowed  in  these  formulas.  A  small  delicate  baby  will  require 
less  than  the  milk  allowed  in  the  formulas." 

These  formulas  may  be  tabulated  as  shown  on  p.  177. 

Mixed  Feeding.  Under  some  conditions  the  breast-fed 
baby  is  given  also  a  certain  amount  of  modified  milk,  and 
this  combination  of  natural  and  artificial  feeding  is  termed 
mixed  or  supplementary  feeding. 

A  deficiency  in  the  breast  milk,  ascertained  by  weighing 
the  baby  before  and  after  each  nursing,  may  be  supplied 


THE  MOTHER'S  CARE  OF  HER  BAliV       177 


by  following  eat-h  nursing  with  a  bottle  feeding;  or  for 
some  reason,  one  or  two  breast-feedings,  in  the  course  of 
the  day  are  sometimes  replaced  by  entire  bottle  feedings. 
In  any  case  the  milk  mixture  to  be  used  as  supplementary 
feeding  is  prepared  with  exactly  the  same  painstaking  care 
as  is  the  milk  for  entire  artificial  feeding. 

If  supplementary  food  is  given  because  of  an  inadequate 
supply  of  breast  milk,  it  is  of  great  importance  that  the 
baby  be  put  to  the  breast  regularly,  no  matter  how  little 
food  he  obtains,  for  his  suckling  is  the  best  iiossiblo  means 
of  stimulating  the  breasts  to  secrete  more  milk,  and  of  equal 


Age 


Milk 


Water 


Barley- 
Waier 


Lime- 
Water 


Sugar 


No.  of 
feed' 
ings 


Hours 


Day      I    Night 


3-7  days 

3     ozs. 

7     ozs. 

J^ozs. 

2  teaspoons 

7 

6-9-12-3-6 

10-2 

2d  week 

5       " 

10       " 

1       " 

11/2  tablespoons 

7 

6-9-12-3-6 

10-2 

3d    " 

6       " 

10>^   " 

1       " 

1}^ 

7 

6-9-12-3-6 

10-2 

1  month 

7       " 

11       " 

1       " 

2 

7 

6-9-12-3-6 

10-2 

2      " 

11       " 

13       " 

i'A  " 

2H 

7 

6-9-12-3-6 

10-2 

3      " 

16       " 

16  ozs. 

2       " 

3 

7 

6-9-12-3-6 

10-2 

i      " 

19       " 

15    " 

2       " 

3 

6 

6-9-12-3-6 

10 

5 

211.2    " 

14    •' 

2       •' 

3 

6 

6-9-12-3-6 

10 

6      '• 

24       " 

12    " 

2 

3 

5 

6-10-2-6 

10 

7 

26       •' 

12    " 

2       " 

3 

0 

6-10-2-6 

10 

8      " 

28       " 

11    " 

2       " 

m 

o 

6-10-2-6 

10 

9      " 

30       " 

10  •• 

2       " 

2 

0 

6-10-2-6 

10 

importance  is  the  fact  that  they  will  tend  to  dry  up  if  the 
baby  nurses  less  than  about  five  times  in  twenty-four  hours. 
Moreover,  even  a  little  breast  milk  is  valuable  to  him  and 
he  should  have  the  benefit  of  all  there  is  to  be  had. 

An  entire  bottle  feeding  is  sometimes  given  to  a  baby 
who  is  nursing  satisfactorily  at  the  breast,  in  order  to  give 
his  mother  an  opportunity  to  take  longer  outings  than  are 
possible  between  the  regular  nursings.  And  sometimes  it 
is  to  the  mother's  advantage,  and  therefore  to  the  baby's, 
to  give  him  a  bottle  during  the  night  and  thus  allow  her  to 
sleep  undisturbed. 


178        GETTING  READY  TO  BE  A  MOTHER 

COMMERCIAL  BABY  FOODS 

Since  the  baby's  nourishment  is  prescribed  by  the  doe- 
tor,  you  have  no  reason  to  concern  yourself  with  the  vari- 
ous proprietary  baby  foods  and  canned  and  powdered  milks 
that  are  so  persuasively  advertised  to  young  mothers.  And 
I  earnestly  hope  that  by  the  time  you  finish  this  little  book, 
no  one  will  be  able  to  make  you  believe  that  any  of  these 
foods  is  likely  to  be  satisfactory  if  used  as  a  sole  article 
of  diet  throughout  the  bottle-feeding  period. 

Uncjuestionably  there  are  many  times  and  circumstances 
when  the  temporary  or  supplementary  use  of  a  prepared 
infant  food  or  canned  or  powdered  milk  is  advantageous. 

In  some  cases  of  intestinal  disturbance  a  proprietary  food 
may  be  a  great  boon,  or  while  the  mother  is  traveling  and 
is  unable  to  have  freshly  prepared  milk  formulas  supplied 
to  her  along  the  way.  These  foods  may  be  valuable,  also, 
during  the  summer,  while  one  stays  at  a  hotel  or  boarding 
house  where  the  freshness,  cleanliness  or  purity  of  the  milk 
are  uncertain,  or  during  a  sudden  shortage  of  fresh  milk, 
as  may  occur  during  a  strike  or  severe  storm  when  trans- 
portation is  interrupted.  But  you  should  not  use  a  pre- 
pared infant  food  for  any  length  of  time  without  your 
doctor's  order. 

If  you  are  confronted  with  the  necessity  of  choosing 
a  prepared  food,  for  temporary  use,  you  may  be  guided 
by  considering  the  general  objects  and  principles  of 
baby  feeding  and  the  character  of  the  various  foods  at  your 
disposal. 

The  proprietary  foods  may  be  divided  into  two  general 
groups :  one  kind  contains  milk  powder  and  is  usually  added 
to  water,  while  the  other  consists  largely  of  sugar  and 
starch  and  is  added  to  fresh  milk  before  being  given  to 
the  babv. 


THE  MOTHER'S  CARE  OF  II HR  BABY       179 

Canned  milk  is  of  two  kinds;  evaporated,  which  is  un- 
sweetened, and  condensed,  Avhich  is  sweetened.  Evaporated 
milk  is  whole  milk  from  which  part  of  the  water  has  been 
removed,  the  milk  then  being  canned  and  sterilized.  The 
addition  of  water  to  evaporated  milk  restores  it  to  the  com- 
position of  whole  milk  in  many  respects,  but  it  is  still  milk 
that  has  been  heated.  Condensed  milk  is  evaporated  milk 
to  which  cane  sugar  has  been  added  to  aid  in  its  jn-eserva- 
tion.  Since  bacteria  do  not  grow  well  in  highly  sweetened 
foods,  it  is  not  necessary  to  bring  sweetened  condensed  milk 
to  as  high  a  temperature  as  the  unsweetened  product,  to 
prevent  subsequent  bacterial  decomposition.  The  high  per- 
centage of  sugar  in  condensed  milk  quite  obviously  renders 
it  unsuitable  for  continuous  use  as  the  sole  article  in  a 
baby's  dietary. 

Milk  powders  or  dried  milks  are  prepared  by  rapidly 
evaporating  the  water  from  whole  milk,  skimmed  milk  or 
partly  skimmed  milk,  leaving  the  solid  constituents  in  the 
form  of  a  light,  white  powder.  ]\lilk  powder  readily  dis- 
solves in  water,  forming  a  "reconstructed  milk"  which 
closely  resembles  the  fresh  milk  from  which  it  was  pre- 
pared. But  it  must  not  be  forgotten  that  reconstructed 
milk  has  been  heated.  Many  doctors  consider  whole  milk 
powder  the  most  satisfactory  form  of  preserved  milk  which 
is  available  for  baby  food.  Should  it  be  used,  however, 
the  importance  of  keeping  it  tightly  covered  and  in  a  cold 
place  must  be  recognized,  for  the  presence  of  fat  renders 
it  likely  to  become  rancid  if  not  kept  cold. 

ARTICLES   OF   FOOD   WHICH  ARE   SOMETIMES   INCLUDED 
IN  THE  BABY'S  DIETARY 

Barley  water,  sometimes  used  to  dilute  whole  milk,  is 
made  bj*  mixing  the  barley  flour  to  a  smooth  paste  in  cold 
water,  adding  boiling  water  and  boiling  for  twenty  minutes 


180        GETTING  READY  TO  BE  A  MOTHER 

or  cooking  in  a  double  boiler  for  an  hour  straining  and 
adding  enough  water  to  replace  the  amount  lost  in  cook- 
ing.   The  proportions  for  different  ages  are  as  follows : 

Three  months,  V2  level  tablespoonfnl  barley  flour  to  16  oz.  water. 
Six  months,  IV2  level  tablespoonf uls  barley  flour  to  12  oz.  water. 
Nine  months,  3  level  tablespoonf  uls  barley  flour  to  10  oz.  water. 

Potato  Water.  One  tablesi)oonful  of  thoroughly  boiled 
potato  is  mashed  into  one  pint  of  the  water  in  which  the 
potato  was  boiled  and  carefully  strained. 

Spinach.  Spinach  is  carefully  washed,  steamed  for  half 
an  hour  and  mashed  through  a  line  sieve.  It  is  sometimes 
started  at  the  sixth  month ;  one  teaspoonf ul  daily,  gradually 
increased  to  one  or  two  tablespoonfuls  daily. 

Orange  Juice.  The  orange  should  be  dipped  in  boiling 
water  and  wiped  on  a  clean  towel  before  being  cut  and 
squeezed,  to  avoid  possible  infection  of  juice.  It  is  usually 
given  to  babies,  sometimes  as  young  as  one  month  old,  who 
take  heated  milk.  It  is  carefully  strained  and  started  grad- 
ually by  giving  one  teaspoonful  in  water  once  or  twice  daily 
between  feedings  and  increasing  to  I/2  or  1  ounce  by  the 
sixth  month  and  l^/o  to  2  ounces  by  the  end  of  the  first 
year. 

Infusion  of  Orange  Peel.  This  is  sometimes  used  instead 
of  orange  juice,  and  is  made  by  boiling  one  ounce  of  finely 
grated  orange  peel  in  two  ounces  of  water,  adding  a  little 
sugar  to  counteract  the  bitter  taste  and  adding  enough 
sterile  water  to  bring  it  up  to  two  ounces. 

Tomato  Juice.  Canned  tomato  strained  through  a  fine 
sieve,  is  sometimes  given  to  a  baby  a  fcAv  weeks  old,  starting 
with  one  teaspoonful  and  gradually  increasing  to  four  to 
six  ounces  daily. 

Whey.  One  quart  of  whole  milk  heated  to  98°  F.  or 
100°  F.  and  one  half  ounce  of  liquid  rennet  or  one  junket 


THE  MOTHER'S  CARE  OF  HER  BABY   181 

tablet  stirred  into  it  and  allowed  to  stand  half  an  honi- 
or  until  firm  and  solid,  is  poured  into  a  cheesecloth  bag 
and  allowed  to  drain  for  about  an  hour  without  being 
squeezed. 

Protein  Milk.  The  curd  from  one  quart  of  milk,  which 
remains  after  the  whey  is  drained,  as  directed  above,  is 
mashed  through  cheesecloth  in  a  fine  wire  sieve,  with  a 
potato-masher  or  bowl  of  a  spoon  and  the  curd  washed 
through  with  one  pint  of  water.  A  pint  of  buttermilk  is 
added  and  the  mixture  boiled  while  being  stirred  con- 
stantly.   This  is  sometimes  given  in  diarrhea. 

Beef  Juice.  One  pound  of  thick  round  steak,  slightly 
broiled,  is  cut  into  small  pieces  and  the  juice  expressed 
with  a  meat  press  or  a  lemon  s(iueezer,  the  amount  varying 
from  2  to  3  ounces.  It  nuiy  be  diluted  with  an  equal 
amount  of  warm  water,  or  slightly  warmed  by  being  placed 
in  a  cup  standing  in  hot  water,  and  salted  to  taste. 

Broths.  One  pound  of  lean  meat,  all  fat  and  gristle  re- 
moved, is  allowed  to  one  pint  of  water.  The  meat  is  cut 
finely  and  put  on  in  cold  water,  heated  slowly  and  allowed 
to  simmer  for  three  or  four  hours,  when  water  is  added  to 
replace  Avhat  was  lost  in  cooking.  It  is  strained,  the  fat 
removed  and  slightly  salted. 

Oatmeal  Water.  Two  level  tablespoonfuls  of  oatmeal  in 
a  pint  of  boiling  water  is  cooked  in  a  d()ul)le-boiler  for  two 
hours,  strained  and  enough  boiling  water  to  replace  the 
amount  lost  in  cooking. 

BATHING  AND  DRESSING  YOUR  BABY 

By  the  time  you  assume  your  baby's  care  he  will  prob- 
ably be  having  his  daily  bath  in  a  tub.  It  may  be  given 
under  a  spray,  however,  or  the  doctor  may  prefer  to  have 
him  sponged.     The  sponge  bath   may  be  given  in  your 


182       GETTING  READY  TO  BE  A  MOTHER 

lap  or  on  a  table  covered  with  a  pad,  either  method  being 
satisfactory  if  the  baby  is  kept  warm  and  comfortable.  But 
one  inclines  to  the  idea  of  having  the  baby  bathed  in  the 
lap  for  he  seems  happier  there ;  more  comfortable  and  less 
frightened  and  we  cannot  be  sure  that  these  factors  are 
unimportant  to  even  a  tiny  baby. 

The  best  time  for  the  daily  bath,  during  the  first  three 
or  four  months,  is  about  an  hour  before  the  second  feeding 
in  the  morning.  After  this  age  the  full  bath  is  sometimes 
given  before  the  six  o'clock  feeding,  in  the  evening,  for  a 
bath  at  this  hour  is  soothing  and  restful  and  often  helps 
toward  giving  the  baby  a  good  night. 

Preparation  for  the  bath  should  be  made  with  its  possible 
effects,  both  good  and  bad,  in  mind,  for  the  baby  may  be 
helped  or  harmed  according  to  the  skill  with  which  he  is 
bathed.  He  must  not  be  chilled  during  his  bath,  and  fatigue 
and  irritation  must  be  avoided  by  giving  it  quickly  and 
with  the  least  possible  handling  and  turning.  These  ends 
may  be  served  by  conveniently  arranging  all  of  the  articles 
which  will  be  needed,  on  a  low  table  at  the  right  hand  side 
of  your  chair,  before  the  baby  is  undressed. 

There  should  be  a  pitcher  of  hot  and  one  of  cold  water ; 
a  bath  thermometer  ;  two  soft  washcloths ;  soft  towels ;  bath 
blankets ;  Castile,  or  some  other  mild  soap ;  boracic  acid 
solution ;  sterile  cotton  pledgets ;  large  and  small  safety- 
pins,  or  large  ones  and  a  needle  and  thread  if  the  band  is 
to  be  sewed  on ;  unscented  talcum  powder ;  sterile  albolene 
or  olive  oil ;  soft  hair  brush  and  a  complete  outfit  of  cloth- 
ing. The  little  garments  should  be  arranged  in  the  order 
in  which  they  will  be  put  on,  the  petticoat  slipped  inside 
the  dress,  and  in  cold  weather,  all  hung  before  the  fire  or 
heater,  to  warm. 

The  temperature  of  the  room  should  be  about  72°  F. 
and  if  it  is  possible  to  bathe  the  baby  before  an  open  fire 


THE  MOTHER'S  CARE  OF  IlKK  P.AIiV      18:j 

or  a  heater,  so  much  the  better.  In  any  case  he  must  be 
protected  from  drafts  and  a  sheet  hung  over  the  backs  of 
two  straight  chairs  will  serve  very  well  as  a  screen  if  no 
other  is  available. 

The  tub  or  basin  should  be  about  three-quarters  full  of 
water  at  100°  F.  for  the  new  baby;  about  95°  F.  after  the 
third  month  and  gradually  lowered  to  85°  F.  or  90°  F.  for 
the  baby  a  year  old.  The  temperature  of  the  Avater  should 
not  be  guessed  at,  but  tested  with  a  thermometer,  though 
in  an  emergency  you  may  safely  use  water  that  feels  com- 
fortably warm  to  your  elbow. 

Lay  a  folded  towel  in  the  bottom  of  the  tub,  before  be- 
ginning, as  babies  are  often  frightened  by  coming  in  con- 
tact with  the  hard  surface. 

It  is  a  good  plan  to  wear  a  waterproof  apron,  covered 
with  one  of  flannel  over  which  is  laid  a  soft  towel,  until  the 
bath  is  finished.  The  towel  is  then  slipped  out,  leaving  the 
dry,  flannel  apron  to  wrap  about  the  baby.  Wash  your 
hands  thoroughly  with  hot  water  and  soap,  before  begin- 
ning; sit  squarely,  Avith  your  knees  together,  on  a  chair 
without  arms ;  take  the  baby  in  your  lap  and  undress 
him  under  a  blanket.  In  order  that  the  bath  may  be 
given  deftly  and  quickly  it  is  well  to  bathe  the  different 
parts  in  the  same  order  every  day,  for  practice  makes 
perfect. 

It  is  usually  a  routine  to  weigh  the  baby  every  morning, 
during  the  first  two  or  three  weeks  and  once  or  twice  a 
week  afterwards,  though  premature  babies  and  those  who 
are  frail  are  sometimes  weighed  at  longer  intervals  because 
of  the  inadvisability  of  disturbing  them  so  often.  The  baby 
is  undressed  for  his  bath,  wrapped  in  a  blanket,  and  laid 
in  the  scoop  or  basket  of  a  beam  scale  and  a  note  made 
of  the  entire  weight,  for  if  he  is  placed  in  the  scales  without 
protection  he  is  likely  to  be  chilled  and  frightened.     The 


154       GETTIN'G  READY  TO  BE  A  MOTHER 

-^i-.zht  of  the  blanket  is  aseertained  separately  and  deducted 
ir  :ii  the  total  thus  giTing:  the  baby's  exact  weight. 

T:  f  -~^  should  be  bathed  firsts  with  pledgets  of  sterile 

.::  p»ed  in  warm  boraeie  acid  solution,  each  pledget 

-     -        ':.'.  onee.    To  prevent  the  solution  from  running 

7  ~:k  the  other,  the  baby's  head  is  turned 

.  r   "  -   le^  and  the  lower  eye  wiped  gently  from 

-ard.     The  lids  may  then  be  separated  by 

piiaemg  '    below  the  brow  and  lifting  it  slightly, 

and  the  r  -d  with  a  gentle  stream  by  squeezing  a 

fre^y  soaked  pledget  just  above  it.    The  head  is  turned  to 

the  other  dde  and  the  eye  on  that  side  bathed  in  like 

manner. 

The  month  is  swabbed  out  very  gently  with  boricnsoaked 
eotton  wrapped  about  the  tip  of  the  little  finger,  care  being 
taken  not  to  injure  the  delicate  mucous  lining.  The  nos- 
trils are  cleaned  with  little  spirals  of  eotton  dipped  in 
mineral  oil  or  olire  oiL 

The  £aee  is  then  washed  with  warm  water,  no  soap,  and 
patted  dry.  The  scalp,  neck  and  ears  are  wa^ed  with  soap 
and  water  and  thoroughly  dried  by  patting  and  by  wiping 
gentty  in  the  creases.  The  body  should  then  be  soaped  with 
your  hand,  only  one  part  being  uneovered  at  a  time  in 
order  to  avoid  chilling. 

To  place  the  baby  in  the  tub,  slip  your  left  hand  under 
his  head  in  such  a  way  that  it  will  rest  upon  your  wrist 
as  your  fingers  spread  out  to  support  his  shoulders.  Tour 
thumb  naturalhr  curves  over  and  holds  the  upper  part  of 
the  baby'^s  arm  without  pulling  or  straining  it.  Grasp  his 
ankles  with  the  right  hand  and  lower  the  little  body  into 
the  water,  feet  first,  as  shown  in  Fig.  50.  This  gradual 
lowering  of  the  baby  into  the  water  is  worth  while,  for 
he  is  like^  to  be  frightened  if  he  is  plunged  in  suddenly. 
11  the  baby's  arm  and  shoulder  are  firmly  held  and  sup- 


186        GETTING  READY  TO  BE  A  MOTHER 


Fig.  51. — Method  of  comfortably  supporting  the  baby's  head  above 
the  water  wliile  giving  his  bath. 


ported  by  your  left  hand,  it  is  an  easy  matter  to  steady 
his  entire  body  and  keep  his  head  out  of  the  water  Avhile 
giving  the  bath  with  your  right  hand,  as  in  Fig.  51. 

The  new  baby  is  not  usually  kept  in  the  tub  for  more  than 
two  or  three  minutes,  but  when  he  is  three  or  four  months 


THE  MOTHER'S  CAIJE  OF  HER  BABY      187 

old  he  may  stay  in  for  five  minules  and  still  longer  as  he 
grows  oldei-. 

Hot  water  should  never  he  poured  into  the  tuh  after  the 
baby  has  been  plaeed  in  his  hath  hut  cold  water  is  often 
added,  for  a  three  or  four  months  old  baby,  or  the  warm 
hath  followed  by  a  quiek  sponge  with  eold  water.  The 
little  body  is  ((uickly  patted  dry,  afterwards,  and  rubbed 
briskly  with  tiie  ])alm  of  the  hand;  the  legs  and  arms 
stroked  toward  the  body ;  the  baek  from  the  neek  down- 
ward and  the  ehest  and  abdomen  with  a  eireular  motion. 
Babies  who  react  well  to  eold  baths  are  benefited  by  them, 
but  those  who  do  not,  may  be  harmed.  Such  "toughening" 
methods,  to  be  benefieial,  therefore,  must  be  adjusted  very 
carefully  to  the  individual  baby  and  should  be  employed 
only  in  aeeordanee  with  the  doctor's  directions. 

The  genitals  should  be  bathed  and  dried  with  care ;  in- 
spected daily  and  any  unusual  appearance  reported  to  the 
doctor.  It  is  not  uncommon  for  girl  babies  to  have  a 
slight  bloody  discharge  from  the  vagina.  Although  this 
is  unimportant  and  soon  disappears,  your  doctor  should  be 
told  of  any  discharge,  however  slight.  The  doctor  often 
washes  to  have  the  foreskin  of  boy  babies  retracted  every 
morning  at  the  time  of  the  bath,  by  gently  rubbing  it 
back  with  gauze  or  cotton,  taking  pains  that  it  is  pulled 
forward  to  the  original  position  after  the  part  underneath 
has  been  thoroughly  bathed  with  boracic  acid  solution.  If 
retraction  is  impossible  after  several  daily  attempts,  the 
baby  is  not  infrequently  circumcised. 

The  care  of  the  baby's  teeth  is  a  part  of  the  bath  and 
should  begin  when  the  first  tooth  appears.  It  should  be 
wiped  front  and  back  with  a  piece  of  gauze  or  cotton  dipped 
in  boracic  acid  or  soda  solution  or  some  other  weak  alka- 
line wash,  to  neutralize  the  acid  secretions  of  the  mouth 
as  these  favor  decay.     After  the  baby  has  five  or  six  teeth, 


188       GETTING  READY  TO  BE  A  MOTHER 

the  use  of  a  very  soft  brush  with  tooth  paste  is  often 
advised,  the  teeth  being  brushed  with  a  circular  motion  or 
from  the  gums  toward  their  edges.  The  teeth  should  be 
wiped,  or  brushed,  morning  and  evening  and  after  feed- 
ings. The  reason  for  such  close  care  of  the  temporary  teeth 
is  that  they  serve  as  a  mold  or  brace  to  hold  the  jaws  in 
proper  shape  for  the  permanent  teeth  which  appear  later. 
If  the  "milk"  or  first  teeth  decay  or  crumble  away  before 
the  jaws  are  developed  to  the  point  when  the  permanent 
teeth  appear,  these  second  teeth  are  likely  to  be  crowded, 
crooked  and  uneven. 

After  all  of  these  details  have  been  attended  to  and 
the  entire  body,  including  creases  and  folds,  has  been 
patted  quite  dry,  it  may  be  dusted  with  an  unscented  tal- 
cum powder,  but  this  powdering  must  not  be  resorted  to  as 
an  aid  in  drying  the  skin.  In  order  to  prevent  chafing, 
the  buttocks  and  thighs  should  be  wiped  clean  with  oil,  or 
bathed  with  warm  water,  no  soap,  patted  dry  and  powdered 
or  oiled  each  time  that  the  diaper  is  changed. 

The  cord  has  dropped  off,  in  all  probability,  by  the  time 
you  begin  to  bathe  your  baby,  and  the  navel  so  well  healed 
that  you  need  do  nothing  to  it,  but  you  may  be  interested 
to  know  what  painstaking  care  the  nurse  has  given  to  this 
important  detail  of  the  baby 's  toilet.  The  form  and  method 
of  cord  dressings  vary  somewhat  with  different  doctors 
but  in  practically  all  cases  the  dressings  are  sterile,  to 
prevent  infection,  and  porous  in  order  that  air  may  gain 
access  to  the  cord  and  promote  the  drying  process.  The 
dressing  itself  may  consist  of  dr.y,  sterile  gauze  or  gauze  wet 
with  alcohol  wrapped  about  the  cord,  as  shown  in  Fig. 
52 ;  or  it  may  consist  of  squares  of  sterile  gauze  or  muslin 
with  holes  in  the  centers  to  fit  around  the  cord,  and  dusted 
with  some  such  powder  as  boric  acid,  bismuth  or  salicylic 
acid  and  starch.    The  dressed  curd  is  laid  flat  on  the  abdo- 


THE  MOTHER'S  CARE  OF  HER  BABY   189 

men  and  directed  upward  to  prevent  its  being  wet  with 
urine;  a  gauze  sponge  is  placed  over  the  dressing  and  the 


Fig.   52. — Cord   dressed  with  dry   sterile  gauze.      (From  photograph 
taken  at  Johns  Hopkins  Hospital.) 

flannel  binder  applied,  being  sewed  on  or  held  in   place 
with  safety-pins,  as  shown  in  Fig.  53. 

The  band  is  put  on  firmly  and  with  even  pressure,  but 
not  tightly.  ,  It  is  a  mistake  to  think  that  a  tight  band 


190        GETTING  READY  TO  BE  A  MOTHER 

strengthens  the  baby's  abdominal  muscles,  for  it  has  quite 
the  opposite  tendency  and  in  addition  may  give  pain  and 


Tig.  53. — Straight  flannel  binder  applied  over  cord  dressing. 


even  cause  vomiting.    The  band  is  removed  every  morning 
at  the  time  of  the  bath,  or  whenever  it  is  soiled,  but  the 


THE  MOTHER'S  CARE  OB^  HER  BABY   191 

cord  dressing  is  not  usually  taken  ofV  unless  it  is  soiled. 
When  the  eord  finally  didps  oft",  the  straijzht  flannel  binder 
is  replaced  by  a  knitted  band  with  shoulder  sti-aps.  This 
is  usually  worn  for  three  oi-  i'oui-  months,  particularly  in 
cold  weather,  to  provide  a  little  extra  warmth  over  the 
abdomen.  Thin,  delicate  babies  sometimes  need  this  band 
for  a  vear  or  more. 


Fig.  54. — Putting  on  the  diaper  which  has  been  fohled  straight 
throiish  the  middle. 


After  the  band  has  been  applied,  the  warmed  shirt  is  put 
on  and  then  the  diaper.  There  are  two  methods  of  putting 
on  the  diaper. 

One  is  to  fold  the  square  diagonally  and  bring  the  diag- 
onal fold  around  the  baby's  waist.  One  of  the  lower  cor- 
ners is  drawn  up  between  the  thighs,  the  two  corners  from 
the  sides  brought  over  this,  straight  across  the  waistline 
and  not  carried  down  between  the  thighs.  The  fourth 
corner  is  brought  up  over  these  and  all  are  pinned  se- 
curely with  a  safety-pin,  while  two  other  safety-pins  hold 
the  margins  of  the  diaper  together  above  the  knees.  The 
other  method  is  to  fold  the  diaper  straight  through  the 


192       GETTING  READY  TO  BE  A  MOTHER 

center,  forming  a  rectangle  twice  as  long  as  it  is  wide ; 
to  lay  the  baby  on  it  lengthwise,  draw  the  lower  half  up 
between  his  thighs  as  shown  in  Fig,  54,  and  pin  it  on  each 
side  at  the  waistline  and  above  the  knees.     (See  Fig.  55.) 

In  either  case  the  diaper  must  be  put  on  smoothly  and 
care  taken  to  avoid  forming  a  thick  pad  between  the  thighs 
as  this  will  tend  to  curve  the  bones  of  legs,  which,  as  you 
know,  are  still  soft.     Squares  of  soft,  absorbent  material, 


Fig.  55. — How  the  diaper  in  Fig.  54  looks  after  it  has  been  put  on. 


which  may  be  burned,  when  soiled,  placed  inside  the  dia- 
pers will  greatly  facilitate  the  laundry  work. 

The  baby's  diaper  should  be  changed  whenever  it  is  wet 
or  soiled,  for  in  addition  to  making  him  restless  and  fret- 
ful for  the  time  being,  the  skin  about  the  thighs  and  but- 
tocks will  grow  red  and  chafed  if  he  is  allowed  to  wear 
wet  diapers.  AVet  diapers  should  not  be  dried  and  used 
again  but  washed  with  mild  soap,  boiled  and  whenever 
possible,  dried  in  tlie  open  air  and  sunshine.  All  of  this 
makes  it  apparent  that  the  regular  use  of  waterproof 
protectors  is  to  be  condemned  since  a  baby  so  protected 
may  wear  a  wet  diaper  for  some  time  before  it  is  discov- 
ered.    Under   special    circumstances   such    as   a   drive,    a 


THE  MOTHER  S  CARE  OF  HER  BABY   193 

short  journey  or  visit  the  diaper  may  he  covered  l)y  water- 
proof drawers  hut  their  hal)itual  use  will  make  the  haby 
unhappy  and  uncomfortable  and  may  even  result  in  a 
serious  condition  of  the  skin. 

Cominp:  baek  to  dressing  the  baby,  after  his  bath,  we 
find  that  after  the  band,  shirt  and  diai)er  have  been  ad- 
justed the  petticoat  and  dress  are  put  on  with  the  fewest 
possible  motions  and  the  baby's  hair  brushed  upward  from 
his  neck  and  back  from  the  forehead.  He  should  be 
wrapped  in  a  small  blanket,  fed  and  laid  (juietly  in  his 
crib  to  sleep.  If  his  hands  and  feet  are  cold  a  hot-water 
bottle  at  125°  P.  with  a  tlannel  cover,  may  be  placed  beside 
him. 

When  the  baby  is  made  ready  for  the  nigfht  he  may  have 
a  sponge  bath  or  simply  have  his  face  and  hands  sponged 
with  warm  water,  according  to  the  wishes  of  the  doctor. 
The  clothing  which  the  baby  has  worn  during  the  day 
should  be  entirely  replaced.  The  day  and  night  clothing 
may  be  worn  more  than  once,  if  clean  and  if  aired  between 
times,  but  it  is  better  not  to  have  the  baby  wear  the  same 
set  of  clothes  for  twenty-four  hours  at  a  stretch.  In  cold 
weather  a  tape  is  often  run  through  the  hem  of  the  stock- 
inette or  flannel  nightgown  in  order  that  it  may  be  drawn 
up,  bag  fashion,  to  keep  the  baby's  feet  warm.  During 
very  warm  weather  the  baby  sleeps  in  a  thin  cotton  slip. 

YOUR  BABY'S  CLOTHES 

Your  baby's  clothes  w'ere  made  long  since,  of  course,  but 
a  word  about  their  use  is  worth  while  as  they  may  be  very 
influential  in  promoting  the  baby's  well-being.  In  order 
that  his  body  may  be  kept  at  an  even  temperature  the 
warmth  of  his  clothing  must  always  be  adjusted  to  the 
needs  of  the  moment.    The  general  tendency  is  to  dress  the 


194        GETTING  READY  TO  BE  A  MOTHER 

bab}'  too  warmly  and  the  usual  result  is  that  he  perspires ; 
is  listless,  pale,  and  fretful;  sleeps  badly;  is  susceptible 
to  colds  and  other  infections  and  has  poor  recuperative 
powers.  His  digestion  is  likely  to  be  deranged  and  he  may 
have  prickly  heat.  On  the  other  hand,  if  the  baby  is  not 
dressed  warmly  enough  his  hands  and  feet  will  be  cold 
and  his  lips  blue ;  he  will  cry  from  discomfort  and  the 
general  result  may  be  lowered  vitality  and  disturbed  diges- 
tion. If  the  baby's  clothes  are  not  comfortable,  if  they 
pull  and  drag  or  have  tight  bands,  he  will  be  fretful  and 
restless,  with  disturbed  sleep  and  upset  digestion  in  con- 
sequence. 

The  little  wardrobe  will  be  entirely  adequate,  under 
ordinary  conditions,  if  it  consists  of  shirts,  bands,  diapers, 
flannel  petticoats,  dresses,  nightgowns,  flannel  wrappers 
and  sacques.  As  the  petticoats  and  dresses  are  cut  twenty- 
seven  inches  long,  many  doctors  feel  that  they  offer  enough 
protection  for  the  feet  of  the  average  baby  to  make  stock- 
ings unnecessary  until  he  is  from  four  to  six  months  old. 
The  skirts  are  then  shortened  to  ankle  length  and  stockings 
added  to  the  baby's  attire.  Other  doctors  think  it  wiser  to 
put  knitted  socks  or  part  wool  stockings  on  the  new  baby, 
particularly  if  he  is  born  during  cold  weather. 

When  the  baby  begins  to  creep,  he  should  wear  soft 
soled  shoes,  part  wool  stockings  in  cold  weather  and  thin 
cotton  or  silk  ones  during  the  summer,  and  firm  but  flexible 
soled  shoes  as  soon  as  he  tries  to  stand  alone  or  to  walk. 

During  the  first  month  or  two  the  baby  scarcely  needs 
special  clothing  for  outdoor  wear  as  he  may  be  wrapped 
in  one  of  the  flannel  squaries  with  a  casing  run  in  one  cor- 
ner to  form  a  hood,  or  he  may  be  placed  on  a  square  diag- 
onally and  the  upper  corner  folded  about  his  head  and 
held  under  the  chin  with  a  safety-pin.  The  corners  on  the 
sides  are  folded  about  his  shoulders,  the  lower  one  brought 


THE  MOTHER'S  CARE  OF  HER  BABY   195 

up  over  his  feet  and  limbs  and  the  additional  blankets 
tucked  in  over  all.  But  as  the  baby  grows  older  and  moves 
about  in  his  carriage,  he  will  need  a  cap  and  cloak  or  wrap 
with  hood  attached.  In  cold  w^eather  the  cap  should  be 
knitted  or  wool  lined  and  the  cloak  of  soft  woolen  material 
or  wool  lin(>d.  In  moderate  weathei-  tlie  cap  may  be  of  one 
thickness  of  cotton  or  silk,  or  very  light  flainiel,  wliile  on 
very  warm  days  lie  will  need  no  head  covering  at  all. 

To  sum  u]):  The  baby's  clothes  should  be  simple  in  de- 
sign, hang  from  the  shoulders,  fit  smoothly  but  loosely  and 
have  no  constricting  bands;  they  should  be  of  soft,  light, 
porous  material;  their  warmth  always  adjusted  to  the  im- 
mediate temperature  so  that  the  baby  will  be  protected 
from  being  either  chilled  or  overheated.  And  his  clothing 
must  always  be  clean  and  dry. 

AIRING  YOUR  BABY 

An  abundance  of  fresh  air  is  one  of  the  baby's  greatest 
needs  as  it  increases  his  resistance  to  disease  and  his  recu- 
perative powers,  improves  his  appetite  and  aids  digestion. 
In  general,  the  more  the  baby  is  in  the  open  air  and  the 
more  fresh  air  he  has  while  in  the  house,  the  better. 

The  two  factors  which  must  be  considered  in  supplying 
the  baby  with  fresh  air  are  the  condition  and  vigor  of  the 
baby  himself  and  the  immediate  temperature  and  state  of 
the  weather.  His  age  and  the  season  of  the  year  can  be 
only  partial  guides  because  of  the  difference  between  in- 
dividual babies  of  the  same  age  and  the  variations  in  tem- 
perature, winds  and  moisture  during  any  one  season. 

The  air  of  the  room  which  the  baby  occupies  should  be 
changing  constantly  in  order  that  it  may  always  be  fresh,  ^ 
but  the  temperature  should  be  equable  and  the  baby  pro- 
tected from  drafts.     As  the  tendency  here,  as  with  the 


196        GETTING  READY  TO  BE  A  MOTHER 

baby's  clothes,  is  toward  overheating,  you  will  do  well  to 
remember  that  the  young  baby  who  lies  covered  up  in  his 
crib,  may  usually  be  kept  an  a  colder  room  than  is  advis- 
able for  an  older  one  who  is  creeping  or  walking  about. 

During  cold  weather  the  baby's  bed  should  not  be  di- 
rectly in  front  of  an  open  window  and  he  should  be  pro- 
tected from  direct  currents  of  cold  air  by  a  sheet  hung 
over  the  head  and  side  of  his  crib. 

Two  or  three  times  daily,  while  the  baby  is  out  of  the 
room,  the  windows  should  be  opened  wide  to  air  the  room 
thoroughly,  one  of  these  airings  being  just  before  the  baby 
is  put  to  bed  for  the  night. 

The  doctor's  usual  instructions  concerning  the  tempera- 
ture of  the  nursery  are  to  keep  it  from  68°  F.  to  70°  F. 
during  the  day  and  about  65°  F.  at  night,  during  the  first 
three  months  and  lower  it  gradually  to  64°  F.  during  the 
day  and  about  55°  F.  at  night  as  the  baby  grows  older.  It 
is  customary  to  begin  to  open  the  nursery  window  at  night 
when  the  baby  is  three  or  four  months  old,  if  he  is  well  and 
the  temperature  is  above  freezing. 

In  planning  to  take  the  baby  out  of  doors  it  is  wiser, 
as  a  rule,  to  begin  with  the  indoor  airing  when  he  is  about 
a  month  old,  except,  of  course,  during  the  moderate  or  mild 
months  of  the  3'ear,  when  he  is  taken  out  at  once.  If  the 
weather  is  cold,  the  baby  may  be  protected  with  extra  wraps 
and  carried  in  the  arms,  into  a  room  in  which  the  windows 
are  open  and  kept  there  for  fifteen  or  twenty  minutes. 
This  indoor  airing  is  increased  by  being  gradually  length- 
ened to  two  or  three  hours  and  by  having  the  windows 
opened  wider  and  wider.  By  the  time  he  is  two  or  three 
months  old  he  is  taken  out  of  doors  on  clear,  bright  days, 
the  best  time  being  between  ten  and  three  o'clock,  when  the 
sun  is  high.  If  he  is  carried  in  the  nurse's  arms  at  first 
the  warmth  of  her  body  serves  as  a  protection  and  helps  to 


THE  MOTHER-R  CARE  OF   HER  R.AIJY       197 

accustom  him  to  the  out-of-door  life,  when  he  spends  a  good 
deal  of  his  time  out  of  doors  in  his  carriafrc 

On  windy,  stormy  days  or  when  thci-c  is  melting  snow 
on  the  ground,  the  baby  may  be  given  his  airing  on  a  pro- 
tected porch  or  in  a  room  with  the  windows  oi)en.  lie  is 
not  usually  taken  out  if  the  temix'rature  is  below  freezing 
until  the  third  or  fourth  inoiitli.  After  this  time  the 
average  baby  is  taken  out  when  the  temperature  is  not 
lower  than  20°  F. 

When  the  baby  is  dressed  in  his  extra  wraps  he  must  be 
taken  out  of  doors  or  the  windows  o])e)ied  immediately,  for 
otherwise  he  will  become  overheated  and  be  in  danger  of 
chilling  when  taken  into  the  colder  air. 

Warm  hands  and  feet,  a  good  color  and  the  baby's  tend- 
ency to  sleep  most  of  the  time  while  out  of  doors  are  evi- 
dences of  his  being  adequately  clothed  for  his  airing,  while 
the  reverse  is  true  if  he  is  not  warm  enough. 

A  robust  baby  who  has  been  gradually  accustomed  to 
being  out  of  doors  during  the  day  will  usually  be  much 
benefited  by  sleeping  out  at  night.  But  he  must  be  pro- 
tected from  winds  and  his  clothing  so  arranged  that  he  can- 
not be  chilled.  Knitted  or  flannel  sleeping  garments  or 
sleeping  bags  (See  Fig.  20)  are  valuable  and  in  addition, 
the  blankets  which  cover  the  baby  should  be  securely  pinned 
to  the  mattress  with  safety-pins  and  tucked  well  under 
it  at  the  sides  and  foot.  The  baby  should  wear  a  warm  cap 
and  the  bed  should  be  warmed  before  he  is  put  into  it.  Or 
better  still,  he  may  be  dressed  for  the  night,  put  to  bed  in 
a  warm  room  and  the  crib  then  moved  out  on  the  sleeping- 
porch. 

An  excellent  device  for  protecting  the  l)aby's  arms  and 
chest,  and  keeping  him  generally  well  covered,  is  the  ]ioneho 
(Fig.  56)  devised  by  Dr.  Lucy  Porter  Sutton  of  Bellevue 
Hospital.     The  poncho  is  a  rectangle  made  of  flannel,  out- 


198        GETTING  READY  TO  BE  A  MOTHER 

ing  flannel  or  an  old  blanket  and  cut  large  enough  to  tuck 
well  under  the  head  and  sides  of  the  mattress  and  extend 
below  the  baby's  feet.  The  baby's  head  slips  through  an 
opening,  which  is  almost  a  right-angled  slit,  equally  distant 
from  the  sides  of  the  poncho  and  about  20  inches  from 


Fig.  56. — The  "Sutton  Poncho"  which  keeps  even  a  restless  baby 
well  covered.  The  insert  shows  how  to  make  the  slit  for  his  head  to 
pass  through.  The  regular  bedding  is  turned  back  in  this  picture. 
(From  a  photograph  taken  at  Bellevue  Hospital.) 


the  top.  The  slit  is  firmly  bound  and  provided  with  tapes 
to  tie  it  together  after  the  baby  is  put  in.  The  poncho 
should  be  put  on  loosely  enough  to  permit  the  baby  to  move 
about  at  will  beneath  it.  After  it  is  adjusted  the  bed  is 
made  up  as  usual  with  additional  blankets. 

Under  all  conditions  the  baby 's  airings  must  be  increased 


THE  MOTHER'S  CARE  OF  HER  BABY   199 

gradually,  both  as  regards  lowerino:  the  temperature  and 
lengthening  the  time,  and  always  adjusted  to  the  vigor  and 
reaction  of  the  individual  baby.  He  must  be  warm,  but 
not  too  warm ;  he  must  be  protected  from  wind  and  dust, 
and  his  eyes  shielded  from  glare  and  from  flickering  light, 
such  as  may  be  caused  by  a  tree  in  a  light  breeze. 

EXERCISING  YOUR  BABY 

Although  the  baby  should  not  be  handled  unnecessarily 
nor  tossed  about  and  played  with  by  friends  and  relatives, 
it  is  important  that  his  muscular  development  be  promoted 
by  regular  and  carefully  planned  exercise.  It  is  usually 
considered  best  for  the  baby  to  lie  quiet  and  undisturbed  in 
his  crib  most  of  the  time  during  the  first  three  or  four 
weeks.  Dr.  Griffith  begins  the  baby's  exercise  about  that 
time  by  having  the  nurse  or  mother  take  him  in  her  arms 
on  a  pillow  and  carry  him  about  for  a  few  moments  several 
times  daily.  After  a  week  or  two  of  this  form  of  exercise 
the  baby  is  carried  in  the  arms  without  a  pillow  but  with  his 
head  and  back  carefulh^  supported  as  the  nurse  is  doing 
in  Fig.  57.  The  position  of  the  baby's  body  is  changed  by 
his  being  carried  about  in  this  way  and  the  movement  of 
the  nurse  or  mother  as  she  walks,  causes  a  certain  amount 
of  motion  of  the  baby's  muscles  which  constitutes  a  gen- 
tle exercise.  The  baby  should  be  carried  first  on  one  arm 
and  then  on  the  other  in  order  that  both  sides  of  his  body 
may  be  equally  exercised. 

This  semi-passive  form  of  exercise  by  means  of  being 
carried  about  is  regarded  by  many  doctors  as  almost  indis- 
pensable to  the  baby's  welfare.  There  is  a  possibility 
that  lack  of  this  form  of  "mothering"  is  one  reason  why 
babies  in  institutions  sometimes  fail  to  progress  as  they 
should.  Certainly,  it  is  inadvisable  for  the  baby  to  be  al- 
lowed to  lie  for  very  long  in  one  position. 


200 


GETTING  READY  TO  BE  A  MOTHER 


By  the  third  or  fourth  month  the  baby  sits  up  in  his 
mother's  arms,  as  she  carries  him  about,  and  he  may  be 
placed  on  the  outside  of -his  crib  coverings  for  a  little 


Fig.  57. — Method  of  carrying  baby  to  suj^port  his  head  and  back. 


while  every  day,  to  kick  and  struggle  at  will.  His  skirts 
should  be  rolled  up  under  his  arms,  or  removed  entirely,  to 
leave  his  legs  quite  free,  care  being  taken  that  the  room  is 
warm  and  that  he  has  on  stockings. 


THE  MOTHER'S  CARE  OF  UVAl  I'.AUV      201 

By  about  the  sixth  iiioiilli  lie  will  usually  l)c<i,'iu  to  make 
an  effort  to  I'lrcp,  if  turned  ovci'  on  his  stoiuach  and  h('l[)ed 
a  little,  and  he  may  be  propped  up  in  the  sitting  position, 
in  his  erib,  for  a  few  moments  every  day.  As  he  gives  evi- 
dence of  having  enough  enei'gy  to  creep  farther  than  the 
limits  of  his  crib  ))ermit,  he  may  be  ]mt  into  a  creeping 
pen,  or  upon  the  floor  under  certain  conditions.  It  must  be 
remembered  that  the  floor  is  likely  to  be  cold,  drafty  and 
dusty.  You  should  assure  yourself,  therefore,  that  the 
floor  is  warm  and  that  all  drafts  are  cut  off,  and  then  spread 
a  clean  sheet  or  quilt  on  th(>  floor  before  the  baby  is  put 
down  to  creep.  When  the  sheet  is  taken  up,  be  sure  that 
it  is  folded  with  the  upper  surface  inside  in  order  that 
when  it  is  again  init  down  the  baby  will  play  on  that  side 
and  not  on  the  side  that  has  been  next  the  floor. 

A  creeping  pen  or  cariole  or  some  such  provision  is  often 
more  satisfactory  than  the  floor,  consisting  as  it  does  of  a 
railed-in  platform  raised  about  six  or  eight  inches  from  the 
floor. 

The  suggestions  for  exercise,  like  those  for  the  baby's 
airing,  must  be  very  general  since  it  should  always  be  ad- 
justed to  the  powers  of  the  individual  baby  and  directed 
by  the  doctor. 

TRAINING  YOUR  BABY 

Bowels.  It  is  possible  to  train  even  a  very  young  baby 
to  have  regular,  daily  bowel  movements ;  and  this  training 
should  be  started  when  the  baby  is  about  a  month  old.  At 
the  same  hour  each  day  he  may  be  laid  on  a  padded  table, 
or  taken  in  your  lap,  a  small  basin  being  placed  against  or 
under  the  buttocks  and  a  soap  stick  introduced  an  inch  or 
two  into  the  rectum  and  moved  gently  in  and  out.  This 
slight  irritation  will  usually  result  in  the  baby's  emptying 
his   bowels   almost    immediately.      Another   method   is   to 


202        GETTING  READY  TO  BE  A  MOTHER 

hold  the  baby  in  a  comfortable,  reclining  position,  on  a 
small  chamber  in  your  lap,  as  in  Fig.  58  or  with  his  back 
supported  against  your  chest,  and  the  desire  to  empty  his 
bowels  stimulated  by  using  the  soap  stick  as  described.  (A 
soap  stick  is  simply  a  piece  of  soap  about  three  inches  long 
whittled  down  to  about  the  size  and  shape  of  a  lead  pencil 
with  a  blunt  point.) 


Fig. 


58. — A  comfortable  position  for  the  baby  who  is  being  trained 
to  use  a  chamber. 


It  is  of  considerable  importance  that  the  position  and 
method  which  are  adopted,  be  employed  at  exactly  the  same 
time  each  day  in  order  to  establish  a  habit.  If  this  is  done 
and  the  baby  is  being  properly  fed,  it  will  usually  be  found 
that  before  he  is  many  months  old,  his  bowels  will  move 
freely  and  regularly  without  the  stimulation  of  the  soap 
stick  and  only  when  he  is  resting  on  the  small  chamber 
or  basin  that  he  is  accustomed  to  using.  This  establish- 
ment of  a  regular  bowel  movement  not  only  simplifies  the 


THE  MOTHER'S  CARE  OF  HER  BABY   20:] 

laundry  work  and  the  care  of  the  baby  but   is  of  great 
moment  to  his  health. 

Thumb  Sucking.  It  is  si-areely  necessary  nowadays  to 
tell  a  mother  that  her  baby  must  not  be  alloAved  to  suck 
on  an  empty  bottle  or  a  pacifier  nor  be  permitted  to  suck 
his  llmmb.    These  habits  are  very  dirty  and  help  to  spread 


Fig.  59.- — Stiff  cuffs  on  the  baby's  elbows  keep  him  from  sucking 

his  thumbs. 


disease.  The  baby  may  swallow  air  while  practicing  them, 
with  colic  as  a  result,  and  he  may  so  deform  the  shape  of 
his  upper  jaw  that  later  in  life,  the  upper  and  lower  teeth 
will  not  meet  as  they  should  for  satisfactory  mastication; 
his  front  teeth  may  protrude  in  a  disfiguring  manner ;  and 
by  narrowing  and  elongating  the  roof  of  his  mouth,  the 
structure  of  the  air  passages  may  be  altered,  with  respira- 


204        GETTING  KEADY  TO  BE  A  MOTHER 

tory  troubles  and  adenoids  as  a  probable  consequence. 
Thumb  sucking-  may  be  prevented  by  the  simple  pro- 
cedure of  putting  stiif  cuff-s  on  the  baby's  elbows,  such 
as  are  shown  in  Fig.  59,  and  which  make  it  impossible  for 
him  to  reach  his  mouth  with  his  thumb.  These  cuff's  are 
easily  made  by  covering  pieces  of  cardboard  with  muslin 
and  attaching  tapes  with  which  to  tie  them  on  the  baby's 
arms.  Another  method  is  to  put  the  baby's  hands  into 
celluloid  or  aluminum  mitts  made  for  this  purpose,  or  little 
bags  made  of  stiff',  heavy  material,  which  in  turn  are  tied 
to  his  wrists ;  or  his  sleeves  may  be  drawn  down  over  his 
hands  and  sewed  or  pinned  with  safety-pins.  It  should 
be  borne  in  mind  that  a  baby  sometimes  sucks  his  thumb 
because  he  is  hungry  or  thirsty  and  will  give  up  the 
practice  when  his  food  is  increased  or  when  he  is  regularly 
given  water  to  drink. 

Ear  pulling  is  not  uncommon  among  young  babies  and, 
if  allowed  to  continue,  a  long,  misshapen  ear  may  result. 
This  may  be  prevented  by  using  a  thin  close  fitting  cap 
which  ties  under  the  chin,  or  by  using  the  same  kind  of 
elbow  splints  as  for  thumb  sucking. 

Crying.  It  is  very  easy  to  allow  the  baby  to  develop  the 
crying  habit  but  very  difficult  to  break  it  up.  The  first 
step  toward  prevention  is  general  good  care,  for  a  baby 
who  is  properly  fed  and  exercised,  kept  dry  and  warm,  but 
not  too  warm,  and  whose  clothes  are  comfortable,  will 
usually  cry  very  little  if  wisely  handled  in  other  respects. 
But  a  baby  may  cry  because  he  is  hungry,  thirsty,  wet, 
cold,  overheated,  sick  or  in  pain  or  simply  because  he  wants 
to  be  taken  up  and  entertained  and  has  learned  that  the 
way  to  realize  his  wish  is  to  cry.  By  examining  the  baby's 
condition  and  observing  his  habits,  it  is  usually  possible  to 
discover  the  cause  of  his  crying.  Very  often  a  drink  of 
fairly  warm  water  will  quiet  him,  particularly  at  night. 


THE  MOTHER'S  CAKE  OF  HER  BABY   205 

Bui  unless  he  sccuis  to  luivo  colic  ;nul  sl()|)s  crying  becaus(! 
of  llu"  i-('li('f  due  lo  the  upriglil  position  in  your  arms,  you 
sliouUl  lu'sitatc  lo  tak<'  tin-  ci-yiug  baby  up  and  carry  liiiii 
about  and  linld  him  when  it  is  discox-crcd  that  this  atten- 
tion sto])s  his  cryinji". 

Persistent  eryinji;  sbouhl  be  reported  lo  your  doctor  as 
it  may  bo  of  some  signilieance. 

KEEPING  YOUR  BABY  WELL  IN  SUMMER 

Notice  that  1  say  kccpiiuj  him.  well.  There  was  a  time 
when  Ave  looked  upon  the  scoui'ge,  variously  known  as 
"summer  eomplaint,"  "summer  diarrhea''  and  "cholera 
infantum"  as  a  seasonal  visitation  that  was  to  be  accepted 
with  resignation.  But  happily  those  dark  days  are  past, 
for  though  the  condition  itself  is  a  complicated  one,  the 
one  big  factor  in  its  causation  was  dirty  milk — milk  that 
was  infected  or  spoiled  or  both — given  to  a  baby  whose 
forces  were  lowered  by  the  heat. 

It  is  perfectly  clear,  then,  isn't  it,  that  a  baby  is  no 
more  likely  to  be  ill  during  the  summer  than  at  any 
other  time,  if  he  is  given  proper  care,  the  kind  of  care 
that  we  have  been  going  over  in  detail?  Each  of  these 
details  is  important  but  .just  bear  in  mind  that  during  warm 
weather  it  is  particularly  urgent  to: 

1.  Feed  the  baby  proi)erly. 

2.  Keep  him  clenii. 

3.  Keep  bini  cool. 

4.  Keep  him  <|uiet. 

The  end  and  aim  of  these  precautions  is  to  prevent  dis- 
turbance of  the  baby's  digestion.  As  babies  suffer  from 
the  heat  more  than  adults  do  and  are  often  excessively  ir- 
ritated and  exj)austed  on  warm  days,  these  results  of  the 


206        GETTING  READY  TO  BE  A  MOTHER 

heat  are  sometimes  enough  to  upset  his  digestion  unless  he 
is  safeguarded  with  greatest  care. 

It  is  much  the  same  as  with  grown  people,  who  often 
find  that  their  digestions  are  upset  solely  by  their  being 
tired  or  excited. 

The  baby  should  have  maternal  nursing  if  possible,  dur- 
ing the  summer,  for  breast-fed  babies  fall  victim  to  summer 
complaint  much  less  frequently  than  de  bottle  babies. 
Quite  evidently,  then,  you  should  regulate  your  own  life 
with  even  more  care  than  usual — for  the  baby's  sake.  He 
should  be  fed  with  absolute  regularity,  and  as  a  rule,  no 
matter  what  the  nature  of  his  food,  it  should  be  reduced 
one  quarter  to  one  third  in  amount  when  the  days  are  very 
hot,  and  he  should  have  an  increased  amount  of  cool,  boiled 
water  to  drink.  His  weight  may  increase  only  slightly, 
or  even  stand  still  for  a  short  time,  as  a  result  of  his  de- 
creased food,  but  you  need  not  worry  about  this  if  he  keeps 
well,  for  the  important  thing  i-s  to  avoid  digestive  disturb- 
ances. It  is  just  the  same  as  with  grown  people  who  are 
advised  to  eat  less  and  lighter  food  than  usual,  while  the 
weather  is  very  warm,  in  order  to  keep  well. 

Cleanliness,  as  at  other  times,  applies  to  the  baby's 
food,  clothing  and  surroundings.  Many  doctors  think  it 
safer  to  have  all  milk  boiled  during  the  summer,  and  of 
course  expect  scrupulous  cleanliness  in  its  preparation  and 
administration. 

The  baby's  soiled  napkins  should  be  placed  immediately 
in  a  covered  receptacle  containing  water,  or  a  disinfecting 
solution  and  not  left  for  even  a  moment  where  they  may 
be  reached  by  flies.  They  should  be  washed,  boiled  and 
dried  in  the  open  air  and  sunshine  as  promptly  as  possible. 
The  baby  should  be  protected  from  Hies  and  mosquitoes 
by  screens  in  the  windows  and  netting  over  his  crib  and 
carriage,  botli  because  these  insects  make  him  restless  and 


THE  MOTHER  •«  CAKE  Ol'  11 1  IK   r.Ai;V       JOT 

irritabU'  and  because  Hies,  ])ai'1iculiii'ly,  are  carriers  of 
(ilth  and  disease — the  kind  of  disease  that  kills  so  many 
babies  during  the  summer.  Aceordinfrly,  you  should  re- 
gard tiies  witii  (h'adly  fear. 

The  baby  should  be  kept  away  from  dusty  places  and 
from  cats  and  dogs.  And  since  he  will  put  his  fingers  into 
his  mouth,  in  s])ite  of  you,  it  is  a  wise  precaution  to  wash 
his  hands  several  tiiiies  a  day. 

The  baby  should  he  in  the  country,  in  the  mountains  or  at 
the  seashore,  if  possible  during  the  warmest  part  of  the 
summer  at  least,  but  if  he  is  in  town  there  is  much  that 
you  can  do  to  keep  him  cool  and  comfortable.  His  cloth- 
ing at  this  season  must  be  adjusted  to  his  condition  and 
the  temperature  of  the  moment  just  as  it  is  in  cold  weather. 
A  thin  shirt,  band,  diaper  and  cotton  slip  will  usually  be 
enough  for  out-of-door  wear,  while  in  the  house  he  may 
often  dispense  with  the  slip,  and  sometimes  with  everything 
but  his  diaper. 

It  is  usually  best  to  take  the  baby  out  of  doors  early 
in  the  morning  and  late  in  the  afternoon,  but  to  keep  him 
indoors  during  the  warmest  part  of  the  day,  when  it  is 
likely  to  be  cooler  inside  than  out,  particularly  if  the 
blinds  are  closed. 

During  excessively  hot  days,  the  baby  will  usually  be 
more  comfortable  if  he  has  two  or  three  cool  sponge  baths, 
in  addition  to  the  soap  and  water  bath,  one  of  the  sponges 
being  given  just  before  he  is  put  to  bed  for  the  night.  He 
should  sleep  on  a  firm  mattress,  preferably  curled  hair 
but  never  feathers,  and  in  the  coolest,  best  ventilated  room 
available. 

He  must  not  be  played  with,  held  on  hot  laps  nor  sub- 
jected to  the  entertainment  and  attention  which  well-mean- 
ing but  misguided  mothers  and  friends  are  so  eager  to  lavish 
on  a  hot,  fretful  baby. 


208        GETTING  READY  TO  BE  A  MOTHER 

Prickly  Heat.  Very  often  during  warm  weather  a  fine 
rash,  known  as  "prickly  heat"  or  heat  rash,  appears  on 
the  back  of  the  baby's  neck  and  spreads  over  his  head, 
neck,  chest  and  shoulders.  As  this  rash  is  due  to  too  warm 
clothing  or  to  the  hot  weather  or  to  both,  less  clothing  and 
frequent  baths  will  often  give  relief.  If  the  baby  is  very 
uncomfortable  he  may  be  greatly  soothed  by  being  im- 
mersed, for  two  to  four  minutes  in  baths,  at  the  tempera- 
ture he  is  accustomed  to,  containing  soda,  bran  or  starch 
in  the  following  proportions: 

Soda  Bath.  Two  tablespoonfnls  of  baking  soda  to  one  gallon 
of  water. 

Bran  Bath.  A  cheesecloth  bag  about  six  inches  square,  partly 
filled  with  bran,  is  soaked  and  squeezed  in  the  bath  until  the 
water  is  milky. 

Starch  Bath.  About  a  cupful  of  cooked  laundi'y  starch  to  one 
gallon  of  water. 

The  baby  should  be  placed  in  the  tub  as  for  his  daily 
bath  and  his  entire  body  submerged,  as  shown  in  Fig.  60, 
•care  being  taken  that  his  ears  are  above  the  surface  of  the 
water. 

No  soap  should  be  used  while  the  baby  has  prickly  heat 
and  after  the  bath  he  should  be  patted  thoroughly  dry  and 
powdered  with  some  such  soothing  powder  as  the  follow- 
ing: 

Powdered  starch   one  ounce 

Oxid  of  zinc    one  ounce 

Boraeie  acid  jiowdei-   00  grains 

Diarrhea.  If  your  baby  has  an  increase  in  the  number 
of  his  movements,  or  if  the.y  become  watery  in  character, 
something  is  wrong.  It  may  be  only  a  mild  disturbance 
or  it  may  be  the  beginning  of  an  attack  of  summer  diarrhea, 


THE  MOTHER'S  CARE  OF  HER  BABY   209 

and  as  at  first  you  cannot  possibly  tell  which  it  is,  you  must 
not  take  it  lip;htly.  Xotit'y  your  doctor  at  once,  but  if 
you  are  remotely  situated  or  he  is  delayed  in  communica- 
ting with  you,  there  are  certain  helpful  things  that  you  cau 


Fig.  60. — Method  of  holding  the  I)aby  in  tiie  tnb  to  keep  all  but  his 
head  covered,  in  giving  a  bran,  starch,  ,so(hi  or  mustard  bath. 


do  for  the  baby  while  waitinpr  for  the  doctor.  The  first 
is  to  give  an  enema  of  half  a  pint  of  water,  at  110°  F., 
containing  Y^  teaspoonful  of  salt.  (See  Fig.  64,  page  217, 
for  method  of  giving  enema.)     If  the  I)aby  seems  to  have 


210        GETTING  READY  TO  BE  A  MOTHER 

only  a  slight  diarrhea  it  may  be  enough  to  reduce  his  food 
one  half,  whether  he  is  breast-fed  or  bottle-fed,  and  to  give 
him  an  abundance  of  cool -boiled  water  to  drink.  If  he 
is  bottle-fed  it  is  a  wise  precaution  to  make  up  his  formula 
with  skimmed  milk  and  leave  out  the  sugar. 

If  the  baby  has  frequent  loose  movements;  seems  fever- 
ish :  vomits  and  cries  as  though  he  had  pain,  stop  all  food 


Tig.  61. — Putting  the  baby  into  a  wet  pack. 

and  give  nothing  by  mouth  but  water,  until  the  doctor 
comes. 

If  you  care  for  your  baby,  yourself,  through  an  attack 
of  summer  complaint  you  will  tind  that  the  doctor's  in- 
structions are  directed  tOAvard  keeping  the  baby  cool,  clean 
and  quiet,  while  he,  himself,  gives  very  careful  attention 
to  the  question  of  feeding. 

It  is  clear,  then,  that  the  baby  should  be  lightly  clad 
and  kept  quiet  and  undisturbed,  in  a  cool  shady  place,  out 


THE  MOTHER'S  CARE  OP  HER  BABY   211 

of  doors  as  imich  as  possible.  During  the  wannest  part 
of  the  day,  however,  he  will  often  he  better  off  in  the  house, 
in  a  room  with  the  shutters  closed.  But  Avhile  keeping  the 
baby  eool,  you  must  beai-  in  mind  the  harm  that  may  be 
done  by  chilling  him  or  exjiosing  him  to  a  cold  draft  or 
wind.  The  doctor  may  want  him  to  have  several  baths 
daily,  possibly  tub  baths,  at  a  temperature  of  100°  F,, 
or  cool  sponge  baths.  Packs,  also,  are  given,  for  they  not 
only  cool  the  baby  but  quiet  him  as  well,  if  he  is  restless. 


Fig.  62. — The  baby  in  a  wet  pack  with  a  hot-water  bag  at  his  feet 
and  cold  compress  on  his  head. 

These  packs  may  be  eool  (80°  F.)  ;  tepid  (100°  F.)  or  hot 
(105°  to  108°  F.)  according  to  the  baby's  needs. 

It  is  a  simple  matter  to  give  a  pack  and  you  will  enjoy 
doing  it  for  you  Avill  actually  see  that  your  baby  will  grow 
rpiieter  and  more  comfortable  as  you  give  it.  Cover  the 
bed  with  a  rubber  and  sheet  and  bring  to  the  bedside  a 
basin  containing  a  sheet  wrung  from  water  of  the  specified 
temperature ;  a  l)asin  containing  ice  and  compresses  for  the 
baby's  head  and  a  flannel  covered  hot-water  bottle  at  125° 
F.,  for  his  feet.  The  baby  is  laid  on  the  upper  half  of  the 
folded  wet  sheet,  and  an  upper  corner  wrapped  about  each 
arm,  as  in  Fig.  61,  and  the  sides  folded  around  his  legs. 
The  lower  half  is  brought  up  between  his  feet  and  used  to 


212        GETTING  READY  TO  BE  A  MOTHER 


cover  his  entire  body,  being  tncked  around  his  shoulders. 
The  hot-water  bottle  is  placed  at  his  feet  and  an  ice  com- 
press on  his  head,  as  in  Fig.  62.  If  the  sheets  are  wrung 
from  warm  or  hot-water,  the  bal)y  is  covered  with  a  blanket 
after  he  is  put  into  the  pack. 


Loujer  half  o(  sVieel 
token  up  betaieen 
Legs  (feel  not 
covered)  to  cover 
body  cornpletely 
and  is  tucUed  under 
shoulders 


Corners  o{  sheet, 
u/rapped  .oround  arms 


■'  Sides  of  sheet 

uraoped  around  leas 


Fig.  63. — Diagrams  showing  the  successive  steps  in  putting  the  baby 

in  a  pack. 

Should  your  baby  have  summer  complaint,  remember  that 
even  a  mild  attack  predisposes  to  another  and  you  will  have 
to  be  even  more  watchful  and  painstaking  than  ever,  in 
your  care  of  him.  He  will  have  to  return  to  his  customary 
diet  very  slowly,  or  he  may  not  be  able  to  take  his  usual 
amount  of  nourishment  at  all  until  the  weather  turns  cool. 
Even  though  he  gains  no  weight  it  is  important  to  avoid 
taxing  his  digestion  since  it  is  already  being  threatened  by 
the  heat. 


TllK   MO'IMIKKS  {\\\{K  OK   IIKK   \',\\'>\       J):: 

KEEPING   YOUR    BABY    WELL    IN    WINTER 

There  arc  certain  evils  llial  Ix'sct  tlic  l)al)y's  way  during 
the  winter  just  as  tlicre  are  seasonal  pitfalls  in  summer, 
but  the  truth  is  that  if  yon  care  for  yourself  and  him  ae- 
cordino:  to  the  suggestions  that  have  been  set  down  in  the 
foregoing  pages,  you  are  doing  practically  everything  nec- 
essary to  make  his  way  safe  and  comfortable.  A  baby  who 
has  proper  food,  plenty  of  fresh  air,  is  kept  clean  and 
whose  daily  life  is  regular,  is  not  likely  to  be  ill  during 
the  winter  or  any  other  time. 

The  chief  baby  ills  that  come  with  the  blustery  weather 
are  colds  and  the  troubles  that  are  likely  to  follow  in  their 
wake,  such  as  bronchitis  and  pneumonia.  Colds  are  infec- 
tious, you  know,  so  keep  the  baby  away  from  sneezy  peo- 
ple and  out  of  crowds  and  dust}-  places.  If  he  should  take 
cold  in  spite  of  you,  send  for  the  doctor  at  once.  It  may 
amount  to  nothing  and  clear  up  in  a  day  or  two,  but  if  you 
let  it  run  on,  the  dreaded  bronchitis  or  pneumonia  may 
result. 

RELIEVING    COLIC,    CONSTIPATION    AND    CONVULSIONS 

I  have  tried  to  impress  upon  you,  at  every  step,  that  it  is 
very  unwise  for  you  to  delay  in  sending  for  the  doctor 
when  your  baby  seems  ill,  or  to  attempt  to  treat  him  ac- 
cording to  your  own  ideas  or  those  of  your  neighbors.  But 
if  the  baby  should  begin  to  scream  with  colic  or  have  a 
spasm,  you  would  want  to  know  what  to  do  at  the  moment, 
and  in  case  of  constipation  there  are  a  few  simple  nursing 
l)rocedures  that  you  may  employ  to  the  baby's  advantage. 

Colic  is  always  due  to  indigestion,  whether  the  baby  is 
breast-fed  or  bottle-fed,  because  of  the  food  itself  being 
wrong  in  some  respect  or  because  it  is  not  properly  given. 


214       GETTING  READY  TO  BE  A  MOTHER 

The  milk  may  contain  too  much  of  the  material  that  forms 
the  curd,  or  so  much  starch  and  sugar  that  fermentation 
takes  place,  the  pain  itself  usually  being  due  to  undigested 
food  or  gas  in  the  intestines.  This  condition  may  also 
result  from  the  baby's  being  fed  too  rapidly  or  too  fre- 
quently, or  from  his  swallowing  air  while  sucking  on  a 
pacifier  or  an  empty  bottle.  Colic  may  be  caused,  too, 
by  chilling  the  baby  as  this  is  likely  to  disturb  his  diges- 
tion. 

Most  babies  have  colic  at  some  time  during  the  first  year, 
usually  before  the  fifth  month.  The  attacks  may  occur 
several  times  a  day,  after  feeding,  or  they  may  not  come 
on  until  the  late  afternoon  or  evening  when  the  baby  is 
tired.  Colic  is  so  common  that  most  people  are  familiar 
with  the  symptoms:  violent  crying  and  a  flushed  drawn 
face ;  cold  hands  and  feet ;  tightly  clenched  fists  and  a  hard, 
swollen  abdomen.  As  the  pain  is  cramp-like,  the  baby 
stops  crying  every  little  while,  and  then  suddenly  begins 
again,  drawing  up  his  legs,  doubling  up  his  body  and 
then  straightening  out  with  a  jerk. 

For  immediate  relief,  j'ou  may  give  the  baby  a  table- 
spoonful  of  hot  water  in  which  half  a  soda  mint  tablet  has 
been  dissolved,  and  an  enema  of  half  a  pint  of  water,  at 
110°  F.,  containing  one  half  teaspoonful  of  salt,  given 
through  a  small  rubber  tube  introduced  about  six  inches. 
This  empties  the  lower  bowel  and  enables  the  baby  to  expel 
a  good  deal  of  the  gas  that  is  troubling  him  so.  Rub  his  ab- 
domen with  a  little  oil  and  apply  a  compress  of  several 
thicknesses  of  flannel,  wrung  from  hot  water,  covering  this 
with  a  larger  piece  of  dry  flannel,  and  change  it  every  three 
or  four  minutes  for  a  while.  Place  a  flannel  covered  hot- 
water  bottle  (at  125°  F.)  at  his  feet,  cover  him  warmly, 
darken  the  room  and  he  will  almost  certainly  go  to  sleep. 
It  is  often  a  good  plan  to  substitute  barley  water  for  one 


THE  MOTHER'S  TAHE  OF  HER  BABY   215 

or  two  feedings,  after  an  attack  of  colic,  in  order  to  give 
the  disturbed  digestive  tract  a  rest. 

Quite  natui-ally,  you  must  tell  your  doctor  if  your  baby 
has  colic  for  the  cause  iiui\'  lie  in  llic  duiracter  of  his  food. 
But  it  may  lie  in  some  erior  on  your  i)art.  Go  over  all 
the  details  of  your  share  of  Ihe  l)aby"s  care  and  see  if  you 
can  discover  anything  to  correct. 

"With  breast-fed  l)abies,  iirevention  is  often  accomplished 
by  the  mother's  nursing  her  baby  more  slowly,  lengthening 
the  intervals  between  nursings  and  by  improving  her  own 
hygiene,  particularly^  by  relieving  constipation  and  increas- 
ing her  recreation  and  out-of-door  exercise.  Nursing 
mothers  who  lead  sedentary  lives  and  eat  rich  food  very 
often  have  colicky  babies  as  do  those  who  are  nervous, 
irritable  and  inclined  to  worry. 

If  the  baby  is  bottle-fed  he  may  be  taking  his  food  too 
fast  because  of  an  over-large  hole  in  the  nipple ;  he  may 
not  pause  often  enough  during  his  meal  or  he  may  take 
in  air  as  he  nurses  because  the  bottle  is  not  properly  held, 
as  shown  in  Fig.  48. 

In  any  event  do  not  stop  until  you  get  at  the  cause  of  the 
trouble  for  though  the  colic  itself  may  not  necessarily  be 
serious,  a  continuation  of  the  cause  may  result  in  a  run 
down  condition  or  even  in  malnutrition. 

Don't  forget  the  importance  of  holding  the  baby  upright 
over  your  shoulder  after  each  feeding,  to  help  him  bring  up 
gas,  and  of  placing  him  immediately  in  his  crib  to  be  left 
quiet  and  undisturbed.  And  ask  your  doctor  about  drink- 
ing water.  Very  often  the  tendency  toAvard  colic  is  les- 
sened by  increasing  the  amount  of  cool  boiled  water  given 
between  meals. 

Constipation  is  very  common  among  babies  and  may  be 
manifest  by  the  stools  being  too  small,  too  dry  or  too  infre- 
quent.   It  is  more  difticult  to  cope  with  than  colic,  though  it, 


216        GETTING  READY  TO  BE  A  MOTHER 

too,  may  have  its  origin  solely  in  unsuitable  food.  In  some 
cases,  however,  the  constipation  is  due  to  absence  of  habit 
in  emptying  the  bowels  regularly ;  to  weakness  of  the  in- 
testinal muscles;  to  long-continued  undernourishment  or 
to  some  such  disease  as  rickets. 

It  becomes  apparent  that  the  prevention  of  this  trouble- 
some condition  is  accomplished  largely  by  giving  suitable 
food;  constant  fresh  air;  regularity  in  the  daily  routine 
and  training  the  baby  to  empty  his  bowels  at  the  same 
time  every  day. 

When  constipation  is  due  to  insufficient  fat  in  the  food, 
cod-liver  oil  is  sometimes  given,  15  to  30  drops  three  or 
four  times  a  day ;  or  a  teaspoonful  of  olive  oil  two  or  three 
times  a  day.  Maltose,  malt  soup,  malted  milk,  milk  of 
magnesia,  mineral  oil,  oatmeal  water  and  orange  juice  are 
all  found  among  the  remedies  for  constipation;  while  soap 
sticks,  suppositories  and  enemas  of  oil  or  soapsuds  some- 
times have  to  be  resorted  to. 

In  giving  an  enema  to  relieve  constipation,  the  baby 
should  be  protected  from  chilling,  laid  on  a  pillow  and  the 
bedpan  so  placed  that  he  will  be  comfortable  and  not  in- 
clined to  move,  and  from  half  a  cup  to  a  cup  of  soapsuds, 
at  105°  F.,  given  with  a  small  hard-rubber  nozzle,  as  in 
Fig.  64.  When  warm  olive  oil  is  given  at  night  (2  to  4 
tablespoonfuls  slowly  through  a  small  rubber  tube  intro- 
duced about  six  inches),  it  is  very  often  retained  until 
morning  when  the  baby  empties  his  bowels  freely  with 
little  or  no  assistance. 

Abdominal  massage  will  often  relieve  constipation  by 
strengthening  the  intestinal  muscles,  this  in  turn  tending 
to  make  the  bowels  move.  The  abdomen  should  be  rubbed 
with  a  firm  but  not  hard,  circular  stroke,  beginning  in  the 
right  groin  and  working  up  to  the  margin  of  the  ribs,  across 
to  the  left  side  and  down  to  the  groin.     This  massage  is 


THE  MOTHER'S  CAKE  OK   IIEK   15A15V       LM7 

often  fifivcii  for  aboul   ton  minutes  every  day,  preferably 
at  night,  but  never  just  after  feeding. 

Constii)ation    is    sometimes    cntii-ely    cured    by    nothing 
more  than  a  suitable  dietary ;  an  abundance  of  drinking 


Fig.  64. — Giving-  the  baby  an  enema.  He  is  well  protected,  to 
prevent  chillino-,  and  lies  comfortably  on  a  pillow  which  reaches  to 
the  bed-pan,  the  latter  l)eing-  covered  with  a  diaper  where  he  rests 
upon  it. 


water ;  an  out-of-door  life ;  massage,  and  above  all,  the 
unceasing  effort  to  establish  a  regular  habit.  These  are 
all  things  whieh  you,  yourself,  may  do  for  the  baby.  The 
longer  constipation  persists,  the  harder  it  is  to  cure,  so  do 


218        GETTING  READY  TO  BE  A  MOTHER 

all  in  your  power  to  prevent  it  and  if  it  develops,  try  to 
end  it  at  once. 

Convulsions  are  a  symptom  of  several  disorders  of  in- 
fancy and  they  may  occur  unexpectedly.  Although  at  the 
moment,  they  are  more  distressing  than  serious,  you  should 
notify  your  doctor  at  once.  If  he  cannot  come  promptly 
you  may  end  the  seizure  by  employing  measures  that  will 
quiet  and  relax  the  struggling  baby.  The  room  should  be 
darkened,  kept  absolutely  quiet  and  the  baby  handled  with 
the  utmost  gentleness.  As  a  rule  the  most  satisfactory 
course  is  to  immerse  the  baby  in  water  at  100°  F.  and  keep 
him  there  for  five  or  ten  minutes,  supporting  his  head  above 
the  level  of  the  water  as  shown  in  Fig.  60.  (See  p.  209.) 
Have  some  member  of  the  household  place  cloths,  wrung 
from  cold  or  iced  water,  on  the  baby's  head  and  change 
them  frequently.  When  removed  from  the  bath,  the  baby 
should  be  wrapped  in  a  blanket,  kept  very  quiet  and  the 
cold  applications  to  his  head  continued. 

If  the  baby  often  has  convulsions  the  doctor  may  instruct 
you  to  give  him  either  a  mustard  bath  or  pack  whenever  he 
has  an  attack. 

For  a  bath,  one  ounce,  or  six  level  tablespoonfuls  of  dry 
mustard  is  added  to  one  gallon  of  water  at  105°  F.  and  the 
baby  kept  in  it  for  about  ten  minutes,  or  until  the  skin  is 
well  reddened.  He  is  then  wrapped  in  a  warm  blanket 
and  surrounded  by  hot-Avater  bottles,  with  cold  compresses 
applied  to  his  head.  The  mustard  pack  is  given  in  the 
manner  shown  in  Figs.  61  and  62,  with  a  sheet  wrung  from 
mustard  water  which  is  possibly  a  little  warmer  and 
stronger  than  that  for  the  bath,  care  being  taken  that  the 
sheet  is  not  cooled  before  it  is  wrapped  about  the  baby. 
He  is  usually  left  in  the  pack  for  about  ten  minutes  or 
until  his  skin  is  reddened,  and  then  wrapped  in  warm 
blankets,  with  cold  compresses  to  his  head. 


THE  MOTIIKKS  CAKE  (»K   I  IKK  BABY      219 

THE  PREMATURE  BABY 

All  of  the  precautions  and  gentlciK'ss  wliicli  are  necessary 
in  the  care  of  the  normal  l)al)\',  Ixti-ii  at  term,  must  be 
greatly  increased  in  caring  for  the  l)al)y  wlio  is  born  pre- 
maturely. The  premature  baby  is  not  only  small,  but  in 
general  is  imperfectly  developed,  having  slenderer  powers 
than  the  full  term  baby,  and  at  the  same  time  much  greater 
needs.  His  resi)iratory  and  digestive  organs  are  less  ready 
to  act  than  those  of  the  normal  baby ;  his  muscles  and 
nerves  are  feeble ;  his  heat-producing  machinery  is  unstable 
and  yet  he  loses  an  excessive  amount  of  body  heat. 

Accordingly,  the  baby  who  has  been  deprived  of  those 
valuable  last  weeks  of  growth  and  development  within  the 
uterus,  is  small  and  limp ;  lies  quietly  most  of  the  time ; 
moves  very  feeblj^  if  at  all,  and  needs  special  care.  To  help 
him  in  maintaining  a  normal  body  temperature  it  is  usually 
necessary  for  him  to  be  oiled  with  warm  olive  oil  and* 
entirely  wrapped  in  cotton  batting  or  flannel  or  enveloped 
in  a  quilted  garment,  with  hood  attached,  made  of  cheese- 
cloth or  flannel  and  cotton  batting,  such  as  is  shown  in 
Fig.  65.  Diapers  are  often  omitted  in  caring  for  very 
feeble  babies,  a  pad  of  cotton,  instead,  being  slipped  under 
the  buttocks,  as  this  may  be  changed  with  less  disturbance 
to  the  baby  than  a  diaper. 

A  satisfactory  bed  may  be  devised  from  a  basket  or  box 
with  the  bottom  well  padded  with  several  inches  of  cotton, 
a  small  jiillow  or  a  soft  blanket  folded  to  the  proper  size, 
covered  with  rubber  or  oiled  muslin  and  a  cotton  sheet. 
The  sides  of  the  basket  may  be  lined  with  heavy  quilted 
material,  to  shut  out  drafts  and  help  to  preserve  an  even 
temperature  of  the  air  immediately  "around  the  baby,  or 
such  a  basket  as  is  shown  in  Fig.  66  may  be  used.  A 
flannel  covered  hot-water  bag  at  110°  F.  may  be  placed 


220        GETTING  READY  TO  BE  A  MOTHER 

beside  the  baby,  or  two,  three  or  four  glass  bottles,  each 
holding  about  a  pint,  containing  water  at  100°  F.  and 
securely  stoppered,  may  be.  hung  in  the  corners  of  the 
basket.     A  thermometer,  also,  should  hang  in  the  basket 


Fig.  65.- — Quilted  robe,  with  hood,  for  the  premature  baby.  It 
may  be  made  of  flannel  or  cheesecloth  with  cotton  batting  for  the 
padding. 

and  the  temperature  kept  between  80°  F.  and  90°  F. 
The  temperature  varies  less  if  the  bottles  are  filled  in 
rotation  than  if  all  are  reheated  at  the  same  time. 

The  amount  of  heat  needed  around  the  baby  is  decided 
by  taking  his  temperature  (by  rectum)  at  regular  intervals; 
supplying  more  heat  if  the  temperature  is  low  and  less  if 
it  is  at  or  above  normal.  Some  doctors  have  the  tempera- 
ture taken  every  four  hours;  others  twice  daily.     As  the 


Fig.  66. — An  improvised  bed  for  the  preiiuitiire  baby,  consisting 
of  a  closely  woven  clothes  basket  with  padded  bottom  and  four 
flannel-covered  bottles  of  hot  water,  attached  to  the  sides.  The 
necessary  thermometer  and  special  feeder  are  shown  in  the  basket. 
(By  courtesy  of  Dr.  Alan  Brown,  Hospital  for  Sick  Children, 
Toronto.) 


221 


222        GETTING  READY  TO  BE  A  MOTHER 

baby  grows  able  to  maintain  a  temperature  of  98°  F.  to 
100°  F.,  unassisted,  the  surrounding  heat  is  gradually 
reduced  and  finally  removed,  and  flannel  clothing  replaces 
the  quilted  robe. 

The  basket  in  which  the  baby  lies  should  be  placed  in  a 
darkened,  well  ventilated  room  and  should  be  carefully 
screened  from  drafts.  As  the  baby  needs  moist  air  there 
should  be  a  large,  open  vessel  of  water  in  the  room. 

Since  the  premature  baby's  lungs  are  not  fully  expanded, 
respirations  are  likely  to  be  shallow  and  irregular,  thus  fail- 
ing to  supply  the  amount  of  oxygen  which  he  needs.  And 
as  crying  always  causes  deep  breathing,  it  is  a  common 
practice  to  make  the  baby  cry  at  regular  intervals  during 
the  day. 

In  feeding  the  premature  baby,  breast  milk  is  the  most 
desirable  food.  In  fact,  many  doctors  feel  that  his  life 
virtually  depends  upon  it.  If  the  baby  is  too  feeble  to 
nurse,  the  milk  may  be  expressed  from  the  mother 's  breast, 
being  immediately  covered  and  placed  in  the  refrigerator 
unless  used  at  once.  Breast  milk  is  sometimes  used  whole 
and  sometimes  diluted  with  sterile  water  and  is  often  given 
from  a  medicine  dropper  or  through  a  special  feeder.  Such 
a  feeder  consists  of  a  glass  tube  with  a  small  nipple  on  one 
end  and  a  rubber  bulb  on  the  other,  by  means  of  which  the 
milk  may  be  gently  expressed  into  the  baby's  mouth.  (See 
Fig.  66.) 

The  premature  baby's  bath  is  of  considerable  importance. 
It  almost  always  consists  of  sponging  him  with  warm  olive 
oil  as  he  lies  in  his  bed  and  with  the  least  possible  exposure 
and  turning.  It  is  given  every  day  or  every  second  or 
third  day,  according  to  his  condition.  Tlie  eyes  are  wiped 
with  boric  pledgets  and  the  nostrils  with  spirals  of  cotton 
dipped  in  oil.  The  buttocks  are  wiped  with  an  oil  sponge 
each  time  the  diaper  is  changed. 


THE  MOTHER'S  CARE  OF  HER  BABY   22:j 

It  nnist  he  hoi-m^  in  mind  constantly  that  tlic  pi'crnalurt' 
baby  is  i)aitii'ularly  snsc'e|)tibl('  to  infection.  lie  should 
be  safeguarded  by  having  everything  tliat  comes  in  contact 
with  bim  scrupulously  clean ;  being  protected  from  drafts, 
chilling  and  dust,  and  allowing  no  one  with  a  trace  of  a 
cold  to  come  near  him.  The  person  who  cares  for  him 
should  wear  a  freshly  laundered  gown  and  protect  her  nose 
and  mouth  with  a  gauze  masiv  while  attending  him, 

TRAVELING  WITH  YOUR  BABY 

Babies  should  not  travel;  that  is  obvious.  But  if  a 
journey-  is  unavoidable,  the  attendant  diflficulties  and  dis- 
advantages may  be  greatly  lessened  by  making  certain 
preparations.  If  the  baby  is  bottle-fed,  the  preparations 
will  depend  upon  the  length  of  the  journey  and  whether  or 
not  it  will  be  possible  to  have  freshly  prepared  feedings,  for 
each  twenty-four  hours,  put  on  the  train  from  laboratories 
along  the  way.  If  this  is  not  possible  and  the  journey  is  not 
to  take  more  than  twenty-four  hours,  the  entire  quantity 
of  food,  ice  cold,  may  be  carried  in  a  thermos  bottle.  The 
requisite  number  of  sterile  nursing  bottles  may  be  taken  or 
one  bottle  which  is  boiled  before  each  feeding.  Or  the  milk 
may  be  prepared  as  usual  and  the  bottles  packed  in  a  port- 
able refrigerator.  Such  a  refrigerator  may  be  bought  or 
one  may  be  improvised.  The  bottles  are  placed  in  a  covered 
pail  and  packed  solidly  in  crushed  ice ;  this  is  placed  in  a 
second  pail  or  a  box  with  a  diameter  which  is  at  least  two 
inches  larger  than  the  inner  pail  and  the  space  between  the 
two  packed  firmly  with  sawdust.  Several  thicknesses  of 
newspapers  should  be  pressed  down  over  the  top  and  a  tight 
cover  fitted  to  the  outer  receptacle. 

The  sterile  nipples  may  be  taken  in  a  sterile  jar  and  a 
deep  cup  or  kettle  will  be  needed  in  which  to  warm  the 


224        GETTING  liEADV  TO  \Mi  A  MOTHEli 

bottle  before  each  feeding;.  It  is  usually  possible  to  obtain 
water  on  the  train  which  is  hot  enough  for  this,  or  cans  of 
solid  alcohol,  a  stand  and  a  metal  tray  may  be  added  to 
the  traveling  outfit.  If  fresh  formula;  cannot  be  delivered 
to  the  train,  daily,  and  the  journey  is  to  last  more  than 
twenty-four  hours,  one  of  the  proprietary  foods  or  a  pow- 


FiG.  67. — If  traveling  is  unavoidable  the  baby  will  be  comfort- 
able and  undisturbed  in  a  basket  converted  into  a  bed.  (By  courtesy 
of  the  Maternity  Centre  Association.) 

dered  milk  will  often  prove  to  be  a  satisfactory  solution 
to  the  problem  of  feeding  the  baby  while  traveling.  The 
course  to  be  followed,  however,  should  be  selected  by  your 
doctor. 

The  baby  will  usually  travel  more  comfortably  and  sleep 
better  if  he  is  carried  in  a  basket.  A  large  market  basket 
with  a  handle  or  a  small  clothes  basket  will  serve.  It  may 
be  lined  with  a  sheet  or  a  blanket ;  have  a  small  hair  pillow 
or  folded  blanket  in  the  bottom  and  be  made  up  like  a  crib. 
(Fig.  67.)     If  this  basket  stands  on  the  car  seat  during  the 


THE  MOTH  Kirs  ("A  UK  OK  HKK   KAISV       225 

day,  and  on  the  fool  of  youi-  hcrtli  a1  iiijrlit,  the  baby  will 
be  cleaner,  (inieter  and  less  ex|)()sc(l  lo  drafts  tlian  if  carried 
in  the  arms. 

As  we  look  back  over  these  pages  of  somewhat  detailed 
description  of  the  baby's  care  it  is  borne  in  npon  us  that 
the  nursing  of  this  unfailingly  delightful  and  engaging 
little  person  has  special  adjustments  and  adaptations  for 
different  seasons  and  circumstances.  But  that  on  the  whole 
the  care  of  all  babies,  the  year  round,  resolves  itself  into 
the  observation  of  a  few  general  principles,  namely:  proper 
feeding;  fresh  air,  rest  and  (piiet:  i-cgularity  in  the  daily 
routine ;  cleanliness  of  food,  clothing  and  surroundings ; 
preservation  of  an  even  body  temj^erature ;  consultation 
with  the  doctor  at  regular  intervals  and  also  whenever  the 
baby  seems  ever  so  little  ill. 

If  you  are  guided  constantly  by  these  general  principles 
and  apply  them  conscientiously,  you  may  revel  in  the  satis- 
fying consciousness  that  you  are  keeping  yonr  pledge  to 
your  baby  by  giving  him  the  best  possible  start  on  his  life's 
journey. 


CHAPTER  XI 
THE  NUTRITION  OF  MOTHER  AND  BABY 

Perhaps  you  are  wondering,  just  a  little,  why  I  devote 
even  a  short  chapter  to  the  subject  of  nutrition  when  I 
have  already  given  you  suggestions  about  dietaries  for 
yourself  and  your  baby.  I  am  doing  so  because  this  ques- 
tion of  nutrition  is  one  of  such  enormous  importance  in 
relation  to  the  baby 's  future  well-being  that  I  want  to  give 
it  special  emphasis. 

It  is  probably  safe  to  say  that  the  two  most  influential 
factors  in  creating  and  maintaining  a  satisfactory  state  of 
health  are  suitable  nutrition  and  the  prevention  of  infec- 
tion. Although  we  shall  concern  ourselves  solely  with 
nutrition,  in  this  chapter,  it  may  be  stated  in  passing  that 
a  state  of  good  nutrition  goes  far  toward  protecting  one 
from  infection. 

It  will  help  to  make  the  entire  matter  clearer  to  explain 
in  the  beginning  that  a  state  of  good  nutrition  is  not  neces- 
sarily evidenced  by  one's  being  tall  nor  by  being  fat.  But 
it  is  evidenced  by  normal  size  and  development ;  sound  teeth 
and  bones ;  hair  and  skin  of  normal  color  and  texture  ;  blood 
of  the  normal  composition ;  stable  nerves ;  vigor  both  mental 
arid  physical;  normally'  functioning  organs;  resistance 
to  disease,  and  above  all  that  indescribable  condition  which 
is  summed  up  as  a  state  of  general  well-being. 

That  this  degree  of  nutritional  stability  is  not  as  preva- 
lent in  this  country  as  might  be  desired  is  disclosed  by 
reports  upon  findings  of  the  examining  boards  for  army 

226 


THE  NUTRITION  OF  MOTHER  AND  BABY     227 

service,  over  a  period  of  three  years,  and  pliysical  examina- 
tions of  various  groups  of  school  children  throughout  the 
country,  it  was  found  in  tiic  first  case,  that  about  sixteen 
per  cent,  of  the  apparently  normal  young  men  who  were 
inspected  for  military  service,  wore  undernourished  in  some 
degree,  and  according  to  Dr.  Thomas  W.  Wood,  Professor 
of  Physical  Education,  Columbia  University,  "Five  mil- 
lion children  in  the  United  States  are  suffering  from  mal- 
nutrition." This  army  of  undernoiirislied  children,  which 
represents  about  one  third  of  the  children  of  the  country, 
is  on  the  broad  highway  to  ill  health,  invalidism  of  various 
kinds  and  degrees,  instability  and  inef^ciency.  They  are 
certainly  not  developing  into  the  clear-eyed,  alert,  buoyant 
individuals  that  go  to  make  up  good  citizenry. 

The  tragic  asi)ect  of  this  state  of  undernourishment  is 
that  though  a  great  deal  can  be  done  to  nourish  and  build 
up  the  malnourislied  child  or  adult,  a  certain  amount  of 
damage  that  results  from  inadequate  nourishment  during 
the  early,  formative  weeks  and  months  cannot  be  entirely 
repaired  later  on  in  life. 

As  the  baby  grows  and  develops,  certain  substances  are 
needed  at  the  various  stages  of  his  progress,  and  if  these 
are  not  supplied  at  these  stages,  there  will  always  be  some 
degree  of  inadequacy  in  the  adult  make  up.  It  is  much  like 
the  futility,  when  building  a  house,  of  using  bricks  without 
straw  for  the  foundation  instead  of  firm,  durable  rock,  and 
then  trying  to  make  the  structure  substantial  and  secure 
later  on  by  using  good  materials  when  building  the  upper 
stories. 

The  solid  foundation  and  substantial  beams  and  girders 
for  men  and  women  are  put  in  during  infancy  and  early 
childhood  in  the  shape  of  good  material  that  forms  good 
nerves,  muscles,  bones,  teeth  and  general  physical  stability. 
It  is  practically  impossible  to  make  up  to  the  older  child  or 


228        GETTING  READY  TO  BE  A  MOTHER 

adult  for  damage  caused  by   failure  to  supply  sufficient 
nourishment  to  the  gr<)\vin<i'.  develoi)iiig'.  infant  body. 

"The  luuviuii  Hnger  writes;  and,  having-  writ, 
Moves  on :  nor  all  thy  piety  nor  wit 
Shall  lure  it  back  lu  cancel  half  a  line, 
Nor  all  thy  teai's  wash  out  a  word  of  it." 

We  see  all  about  us,  tlie  results  of  this  form  of  neglect  of 
babies,  in  the  bow-legged,  knock-kneed,  undersized,  mis- 
shapen, chicken-breasted  adnlts  and  in  those  who  are  nerv- 
ous and  below  par  in  endurance  ;  are  susceptible  to  colds  and 
other  infections  and  may  be  summed  up  as  being  "not 
strong. ' ' 

The  reasons  for  much  of  the  undernourishment  among 
people  in  this  country  to-day  are  to  be  found  in  certain 
widespread  misconceptions  of  long  standing  as  to  what 
constitutes  a  state  of  good  nutrition  or  malnutrition  and 
the  value  and  purposes  of  ditferent  foodstuffs.  For  mal- 
nutrition does  not  necessarily  describe  a  simple  condition 
due  to  an  insufticient  amount  of  food,  but  to  any  one  of 
several  com})lex  conditions  due  to  a  lack  in  the  food  of  one 
or  more  essential  substances. 

One  may  eat  a  large  amount  of  food  and  even  have  a 
well-padded  body  and  yet  be  seiiously  in  need  of  certain 
food  factors — in  other  words,  be  incompletely  nourished  in 
some  particular. 

That  was  possibly  the  first  misconcei)tion — the  belief  that 
one  simply  needed  enongli  food,  and  accordingly  was  well 
nourished  if  three  large  meals  were  eaten  daily,  irrespective 
of  the  composition  of  those  nu^als.  A  step  forw^ard  was 
taken  when  housewives  and  people  generally  accepted  the 
fact  that  quantity  alone  was  not  enough  to  consider  in  pro- 
viding food,  but  that  the  dietary-  slionid  consist  of  balanced 
amounts  of  the  live  food   materials;   fats,  carbohydrates, 


THE  NUTKITIOX  OF  MOTIIKK   AND  P.AP.V     220 

proteins,  mino'als  and  ^\;^tt'l•,  in  oi-dci-  lo  liuild  and  maintain 
the  body  in  a  state  of  hcaltii. 

But  this,  too,  was  found  to  he  an  error,  in  so  far  as  it  was 
only  a  part  of  the  truth,  for  it  was  next  ascertained  that 
even  provision  for  a  suitable  balance  of  the  five  food  groups 
was  not  enough  to  nourish  us,  but  that  we  must  consider 
the  heat-and-enei-gy-producing  properties  of  these  com- 
ponent parts,  as  measured  by  the  caloric  unit,  and  that  we 
must  daily  take  in  tiie  requisite  number  of  calories  if  we 
would  keep  our  engines  going. 

It  is  now  known  that  even  this  is  not  enough,  for  we  may 
eat  food  in  ample  ([uantities,  consisting  of  the  properly 
balanced  fats,  proteins,  carbohydrates,  minerals  and  water, 
and  it  may  daily  yield  the  reijuired  number  of  calories,  and 
still  we  may  sutfer  from  seriously  faulty  nutrition. 

We  find  an  explanation  for  this  fact  in  the  comparatively 
recent  recognition  of  three  substances,  as  yet  not  clearly 
understood,  which  are  contained  in  a  certain  few  articles 
of  food,  each  one  of  which  is  essential  to  growth  and  normal 
health  and  well-being,  though  not  necessarily  concerned  in 
the  production  of  heat  or  energ;v'.  Various  terms  have  been 
applied  to  these  mysterious,  but  necessary  substances,  such 
as  vitaniincs,  accessory  food  substances,  as  applied  to  all, 
or  fat-soluble  A,  water-soluble  B  and  water-soluble  C  to 
designate  them  separately. 

A  surprisingly  small  amount  of  each  of  these  substances 
is  sufficient  to  meet  the  needs  of  an  individual,  but  no  one 
of  these,  even  in  this  small  amount,  can  be  safely  dispensed 
with,  for  if  the  diet  is  deficient,  or  lacking  in  one  or  more 
of  them  some  form  of  nutritional  disturbance  will  result. 
It  may  be  severe  enough  to  be  diagnosed  as  a  disease,  or  it 
may  be  onlj-  enough  to  keep  the  individual  below  a  normal 
state  of  health. 

When  the  disturbance  is  profound  enough  to  produce  a 


230        GETTING  READY  TO  BE  A  MOTHER 

definite,  recognizable  condition,  it  is  designated  as  a  de- 
ficiency disease,  of  which  there  are  three :  scurvy,  beri-beri 
and  xerophthalmia.  AVith  these  are  sometimes  included 
rickets  and  pellagra.  The  exact  cause  of  the  two  latter 
disorders  is  not  definitely  known  but  both  are  associated 
with  faulty  nutrition.  Poor  hygienic  conditions  may  enter 
into  the  causation  of  rickets,  and  infection  may  be  a  factor 
in  the  occurrence  of  pellagra,  but  neither  disease  appears 
in  people  who  are  suitably  fed  while  both  diseases  may 
be  produced  by  faulty  diet  and  both  may  be  cured  with 
suitable  food. 

But  probably  of  graver  importance  to  the  public  welfare 
than  the  well  defined  nutritional  disturbances,  themselves, 
is  the  fact  that  between  a  state  of  good  health  and  the  level 
upon  which  a  disease  is  recognizable  is  a  long  scale,  along 
which  is  ranged  an  uncounted  army  of  under-par,  half- 
sick  people.  These  are  the  ones  who  are  tired,  nervous,  sus- 
ceptible to  infections,  with  feeble  recuperative  powers,  and 
in  general  are  more  or  less  ineffective  in  the  business  of  life. 

It  is  this  borderline  state,  or  as  Dr.  Goldberger  terms  it, 
"the  twilight  zone,"  which  cannot  quite  be  called  disease 
but  is  not  health,  that  is  serious  to  the  masses,  for  diagnosed 
disease  is  given  treatment,  but  nervousness,  lack  of  energj^ 
and  endurance,  weakness  and  inefficiency  are  not  treated ; 
as  a  rule  they  are  merely  tolerated.  The  sufferers  fail  to 
reach  their  highest  possible  development  and  they  fail  to 
be  of  highest  value  to  society. 

This  is  the  condition  which  can  be  so  largely  prevented  by 
giving  the  baby  a  good  nutritional  foundation.  This  must 
be  started  during  his  prenatal  existence,  carried  through 
the  nursing  period  and  then  continued  throughout  the  rest 
of  his  life. 

It  will  mean  much  to  the  coming  generation  if  the  ex- 
pectant and  nursing  mothers  at  large  are  able  so  to  com- 


THE  NUTRITION  OF  MOTHER  AND  BABY     231 

pose  tlieir  diets  that  tliey  will  provide  not  only  the  rociuisite 
fats,  proteins,  carbohydrates,  minerals  and  water  and  yield 
the  necessary  calorics,  but  will  contain,  also,  all  three  pro- 
tective substances:  fat-soluble  A,  water-soluble  B  and  water- 
soluble  C.  It  can  l)e  demonstrated  that  when  these  food 
factors  are  not  present  in  the  mother's  diet,  they  will  not 
appear  in  her  milk,  and  accordingly  will  not  be  supplied  to 
her  baby. 

That  is  the  crux  of  the  wiiole  question.  If  your  diet  is 
faulty,  your  milk  will  be  faulty  in  the  same  respect  and 
your  baby,  being  incompletely  nourished,  will  start  life 
with  tissues  that  are  lacking  in  those  substances  that  are 
needed  to  make  them  sound  and  to  promote  health.  That  is 
what  we  have  in  mind  when  we  say  that  the  mother's  milk 
must  be  satisfactory  not  alone  in  quantity  but  in  quality 
as  well,  if  the  baby  is  to  be  well  nourished. 

In  order  to  make  quite  clear  how  damaging  are  the 
results  of  diets  which  are  deficient  or  lacking  in  protective 
substances  we  shall  have  a  word  about  rickets  and  scurvy, 
the  two  diseases  due  to  faulty  diet,  that  are  so  serious  for 
babies. 

Rickets  is  a  nutritional  disturbance,  common  among 
babies  who  are  fed  solely  or  continuously  on  heated  milk, 
either  boiled  or  canned,  and  on  proprietary  food  and  sweet- 
ened condensed  milk.  Rickets  may  develop,  also,  among 
nursing  babies  whose  mothers  are  on  faulty  diets. 

The  chief  characteristics  of  the  disease  are  arrested 
growth  and  softening  of  the  bones,  with  dwarfism  and  de- 
formities as  a  result.  It  is  essentially  a  disease  of  infancy, 
occurring  as  a  rule,  between  the  fourth  and  eighteenth 
months  but  some  of  its  unfavorable  eft'eets,  such  as  bone 
deformities  and  poor  resistance  to  disease,  may  persist 
throughout  life.  Although  babies  rarely  die  of  rickets 
alone,  it  is  one  of  the  most  serious  of  all  health  problems 


232        GETTING  READY  TO  BE  A  MOTHER 

since  it  predisposes  to  such  diseases  as  bronchitis,  pneu- 
monia, tuberculosis,  measles  and  whooping  cough  and  in 
general  greatly  weakens  the  powers  of  resistance  and 
recuperation. 

The  common,  early  symptoms  of  rickets  are  irritability; 
restlessness,  particularly  at  night ;  a  tendency  to  have  con- 
vulsions from  very  slight  causes;  digestive  disturbances  and 
profuse  perspiration  about  the  head.  Tlie  baby  may  be  fat, 
but  is  likely  to  be  flabby  and  have  a  characteristically  white, 
"pasty"  color.  The  fontanelles  are  large  and  late  in  clos- 
ing; the  abdomen  is -large  and  the  chest  narrow;  teething 
is  usually  delayed  and  the  teeth  may  be  soft,  when  they 
do  come  in,  and  decay  early.  But  the  most  conspicuous 
effect  of  rickets  is  upon  the  bones  which  are  soft,  easily 
bent  and  broken  and  often  misshapen.  Their  growth  is 
likely  to  be  retarded  and  the  ends  of  the  long  bones  may  be 
enlarged,  causing  swollen  wrists  and  ankles  and  the  little 
lumps  on  the  chest,  so  commonly  called  a  "rickety  rosary." 
The  bones  in  the  arms  and  legs  may  become  curved  as  the 
baby  lies  or  sits  in  his  crib,  making  him  either  bow-legged 
or  knock-kneed.  Since  the  soft  bones  are  easily  bent  their 
deformity  is  increased  by  the  baby's  walking  or  by  the 
bunch  which  may  be  formed  between  the  thighs  by  a  large, 
improperly  ai)plied  diaper.  The  si)inal  column  may  be 
curved,  or  too  weak  to  permit  the  baby  to  sit  straight  or 
stand  alone.  The  entire  chest  wall  is  often  deformed,  pro- 
ducing the  familiar  "chicken-breast"  and  so  decreasing  the 
size  of  the  chest  that  the  baby's  breathing  space  is  cut 
down.  This  is  one  reason  why  pneumonia  is  so  serious 
with  a  baby  who  has,  or  has  had  rickets.  The  forehead  is 
prominent  and  the  whole  head  looks  s{|uare  and  larger  than 
normal,  while  the  |)elvic  deformities  in  girl  babies  often 
give  rise  to  very  serious  obstetrical  complications  later 
in  life. 


THE  NUTRITION  OF  MOTIIKU   AND   \'..\l',\     233 

All  of  this,  with  tile  iiiisrry  wliidi  it  entails,  is  due  to 
faulty  iiiitrilioii. 

The  sovereign  icincdics  in  rickets  are  cod-liver  oil  and 
sunshine,  in  addition  to  ^eneial  jiood  care.  But  the 
treatment  is  a  lonji',  slow  process,  taking  from  three  to  fif- 
teen months,  jind  it  is  donlitfnl  if  the  damage  whieh  the 
disease  works  can  ever  l)e  repaired. 

Riekets  is  more  conmion  diiihiL:'  tlie  cold  months  of  the 
year,  winter  and  spi-ing.  than  during  the  milder  summer 
and  autumn  seasons.  A  |)ossiMe  explanation  for  this  lies 
in  the  highei-  value  of  the  cows"  food  durinp:  the  warm 
months  when  green  things  foi-in  the  diets  of  animals.  Since 
it  is  now"  reeogni/.ed  that  milk  is  not  a  constant  product, 
but  that  its  properties  vary  with  the  food  of  the  animals 
that  produce  it,  cows'  milk  would  he  favorably  influenced 
by  their  being  put  to  pastuic. 

Similar  evidence  of  such  an  intluenee  is  seen  in  the  fact 
that  although  riekets  is  not  seen  among  breast-fed  babies 
whose  mothers  are  on  satisfactory  diets,  it  may  and  does 
occur  in  breast-fed  babies  who  are  nourished  by  mothers 
who  are,  themselves,  on  dietaries  which  are  poor  in  milk 
and  fresh  fruit  antl  vegetables. 

It  is  quite  plain  that  a  baby  who  is  fed  and  eared  for  in 
accordance  with  the  suggestions  offered  in  the  preceding 
chapters  is  not  likely  to  develop  rickets. 

Infantile  scurvy  is  seen  among  babies  who  are  fed  solely 
on  milk  that  has  been  heatetl,  boiled,  pasteurized  or  canned, 
since  the  vitamine,  in  milk,  that  |)revents  scurvy  is  practi- 
cally destroyed  by  heating  or  aging.  That  is  one  reason  why 
it  is  dangerous  to  give  stale  milk  to  babies  and  why  you 
should  not  use  canned  milk  on  your  own  resj)onsibility. 
If  the  doctor  orders  it  for  your  baby,  he  will  know  what  to 
give  in  addition  to  the  milk  to  keep  the  baby  from  having 
scurvy. 


234        GETTING  READY  TO  BE  A  MOTHER 

The  disease  develops  slowly,  the  first  symptoms  appear- 
ing between  the  seventh  and  tenth  months.  Tenderness  or 
pain  in  the  legs  is  perhaps  the  most  common  symptom  and 
may  be  detected  first  by  the  baby's  crying  when  his  diaper 
is  changed  or  his  stockings  put  on.  And  a  baby  who  has 
been  cheerful,  playful  and  active  will  prefer  to  lie  quietly 
and  will  cry  whenever  he  is  touched.  He  grows  pale,  list- 
less and  weak  and  fails  to  gain  in  weight  or  length.  His 
large  joints  are  likely  to  be  swollen  and  tender ;  his  swollen 
gums  may  bleed ;  his  urine  be  diminished  in  amount  and 
contain  blood.  But  it  is  entirely  possible  for  a  baby  to  be 
in  serious  need  of  the  vitamine  that  prevents  scurvy  and 
still  not  present  these  well  defined  symptoms  of  the  disease. 
In  such  a  case  there  may  be  stationary  weight,  fretfulness, 
a  muddy  complexion  and  perhaps  tenderness  of  the  bones. 

Scurvy,  of  itself,  does  not  often  cause  death  among 
babies,  but  it  is  serious,  nevertheless,  for  it  makes  the 
babies  very  susceptible  to  infection,  particularly  nasal 
diphtheria  and  "grip." 

The  disease  may  be  either  prevented  or  cured  by  giving 
orange  juice,  potato  water,  spinach  or  tomato  juice  to  a 
baby  whose  diet  consists  of  milk  that  has  been  heated  and 
is  therefore  lacking  in  the  vitamine  that  prevents  scurvy. 

Although  scurvy  is  seldom  seen  in  breast-fed  babies  it 
is  believed  that  an  infant  who  is  nursing  at  the  breast  of 
a  woman  whose  diet  is  lacking  or  deficient  in  fresh  milk, 
oranges  and  leafy  vegetables  will  suffer  a  certain  degree  of 
starvation  and  thus  be  sickly  and  susceptible  to  infection 
without  actually  having  scurvy. 

The  significance  to  you,  of  this  complicated  and  enor- 
mously important  question  of  nutrition  may  be  summed  up 
as  follows : 

1.    There  are  five  recognized  diseases  resulting  from  faulty  nutri- 
tion, which  may  be  either  prevented  or  cured  by  a  diet  which 


THE  NUTRITION  OF  MOTHER  AND  BABY  '2•^7^ 

contains  the  protective  substances,  called  vitaniines,  which  are 
now  regarded  as  essential  to  normal  growth,  development  and 
well-beinir. 

2.  These  essential  substances  are  not  necessarily  provided  in 
adequate  amounts  by  a  diet  that  is  satisfactory  in  bulk  or  in 
its  balance  of  fats,  carbohydrates,  proteins,  salts  and  water  or 
that  yields  the  requisite  number  of  calories.  The  familiar  diet 
of  meat,  i)otatoes,  jieas,  beans,  bread,  pie  and  coffee  is  so  far 
from  providing'  complete  nourishment  that  those  who  are 
limited  to  it  are  in  a  state  of  partial  starvation. 

3.  Although  the  breast  tissues  are  capable  of  convertinsr  into 
milk  certain  substances  which  they  extract  from  the  blood, 
they  cannot  create  the  protective  substances  which  we  have 
been  considering.  They  can  merely  excrete  these  substances 
if  they  are  contained  in  the  mother's  diet.  The  absence,  or 
shortage  of  these  food  essentials  in  the  mother's  diet,  and 
therefore  in  her  milk,  may  result  in  rickets  or  other  mal- 
nourished conditions  in  the  baby,  or  in  a  degTee  of  faulty 
nutrition  which  is  not  marked  enough  to  be  diagnosed,  but 
enough  to  keep  him  frail ;  enough  to  give  him  the  poor  start 
that  is  so  likely  to  put  him,  ultimately,  in  the  class  of  those 
adults  who  are  more  or  less  unfit,  though  not  actually  ill. 

4.  The  great  protective  foods  are  milk  and  leafy  vegetables  and 
any  diet  which  is  poor  in  these  is  incapable  of  nourishing 
satisfactorily. 

By  milk  we  mean  fresh  milk,  first  and  foremost  and  also 
cream,  butter,  buttermilk,  cream  soups  and  sauces,  custards, 
ice-cream  and  all  dishes  and  beverages  made  of  milk. 

By  leafy  vegetables  we  mean  lettuce,  romaine,  endive, 
cress,  celery,  cabbage,  spinach,  onions,  string  beans,  aspara- 
gus, cauliflower,  Brussels  sprouts,  artichokes,  beet  greens, 
dandelions,  turnip  tops  and  the  like. 

Other  foods  which  are  rich  in  protective  substances  are 
fresh  fruit,  egg-yolks  and  glandular  organs,  as  liver  and 
sweet-breads. 


236        GETTING  READY  TO  BE  A  MOTHER 

Nearly  all  of  the  common  foods  are  deficient  in  some 
respect,  but  as  the  shortcomings  of  the  various  groups  are 
different,  we  can  arrange  entirely  satisfactory  diets  by 
combining  foods  which  supplement  each  other's  deficiencies. 
This  explains  to  us  why  the  meat-potato-peas-beans-bread- 
and-pie  type  of  meals  fail  to  supply  adequate  nourishment. 
These  foods  belong  in  the  same  general  group  and  are  de- 
ficient in  about  the  same  kind  of  food  factors,  thus  tending 
to  duplicate,  rather  than  supplement  each  oth'er. 

If  such  a  fare  is  enriched  by  the  addition  of  the  protec- 
tive foods,  milk  and  leaiy  vegetables,  we  have  a  well 
rounded  diet  in  which  the  deficiencies  of  one  group  of 
foods  are  supplied  by  the  properties  of  the  other  groups. 
In  fact,  it  is  only  by  such  a  supplementing  combination 
that  an  entirely  satisfactory  diet  can  be  secured. 

It  is  generally  agreed  that  the  two  big  problems  of  baby- 
hood are  proper  nutrition  and  the  prevention  of  infection, 
but  nutrition  is  perhaps  the  greater  problem,  since  any  form 
or  degree  of  malnutrition  lessens  the  baby 's  powers  to  resist 
and  to  recover  from  infection.  Whether  breast-fed  or 
bottle-fed,  therefore,  it  is  imperative  that  the  baby  be 
nourished  in  the  complete  sense  of  being  given  all  of  the 
food  materials  which  are  essential  to  normal  growth,  de- 
velopment and  protection  against  disease. 

If  your  baby  is  artificially  fed  on  milk  that  has  been 
heated  you  will  understand  why  the  doctor  adds  such  pro- 
tectives  as  cod-liver  oil  and  orange  juice,  since  the  pro- 
tective properties  of  milk  are  impaired  by  heating.  If  he 
is  breast-fed,  you  will  be  able  to  supply  to  your  baby  the 
requisite  nourishment  and  protective  substances  only  if  you 
yourself  are  adequately  nourished  and  in  good  condition. 

That  is  the  point  of  this  discussion;  the  fact  that  you 
must  be  on  a  satisfactory  diet  or  you  cannot  satisfactorily 
nurse  your  baby.     Satisfactory  nursing  means  to  give  to 


THE  NUTRITIOX  OF  MOTHER  AND  BABY  2:^7 

yciir  baby,  fi-oni  the  beginning,  through  your  milk,  tlic 
materials  necessary  to  build  well  and  securely  that  temple, 
in  the  form  of  his  body,  which  he  will  occupy  throughout 
life;  a  structure  so  substantially  built,  from  the  foundation 
up  through  each  successive  stage,  that  it  will  be  able  to 
withstand  the  attacks  of  disease  and  weather  the  inevitable 
storm  and  stress  of  life,  for  perhaps  even  more  than  the 
allotted  three  score  years  and  ten. 

"The  race  marches  forward  on  the  feet  of  little  children." 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW 


AN  INITIAL  FINE  OF  25  CENTS 

WILL  BE  ASSESSED  FOR  FAILURE  TO  RETURN 
THIS  BOOK  ON  THE  DATE  DUE.  THE  PENALTY 
WILL  INCREASE  TO  50  CENTS  ON  THE  FOURTH 
DAY  AND  TO  $1.00  ON  THE  SEVENTH  DAY 
OVERDUE. 


-mt 


fffep 


LibriairY 


FFR  6     1345 


FEB  7 


MAY  2  1 1946 

M 1  4  i§46 


19S6 


J  UN  IG  19/0 


NOV  18 


m^ 


*UG  29  1947 


1  9  lasi 


jU?(  I  ■'   1954 


■ii.'N  I  1 1  I'jj, 


LD  21-100m-7,'40{6936s) 


Un   BERKELEY  LIBRARIES 


CD3T7DbTDl 


,».<SS§>^ 


,0**'^^ 


